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PubMed1989

Tracing specific transmitter pathways in the rat CNS: combination of [3H]serotonin retrograde labelling with immunocytochemical detection of endogenous transmitters.

Selective retrograde labelling with [3H]serotonin ([3H]5-HT) can be used to identify serotonergic cell bodies after specific [3H]5-HT uptake by the corresponding nerve terminals. In the present study, we demonstrate that autoradiography of this [3H]5-HT radiolabelling can be combined with immunocytochemical detection of endogenous serotonin, GABA or substance P on the same tissue section. The midbrain raphe serotonergic projections to the olfactory bulb and the spinal projections of medullary serotonergic nuclei were investigated. The specificity of retrograde labelling with [3H]5-HT was confirmed by immunoreactivity of the radiolabelled cells for serotonin, using an antiserum specific for formaldehyde-fixed serotonin. After spinal injections of [3H]5-HT, many retrogradely labelled cells in the medullary raphe were immunopositive for substance P, and a few for GABA. These results are in agreement with the available information on the co-existence of putative transmitters in the spinal projections of caudal raphe neurons. Therefore, autoradiography of [3H]5-HT retrograde labelling combined with immunocytochemistry offers a possibility to test the specificity of transmitter-selective retrograde labelling, to identify transmitter-defined neuronal interactions and to investigate the projection fields of multitransmitter containing neurons.

Animals↗
PubMed1999

Oxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section.

A novel positioning technique was tested to see whether the unpredictability of block height and haemodynamic instability during spinal anaesthesia for caesarean section could be reduced. In this 'Oxford' position, the woman is placed left lateral with an inflated bag under the shoulder and pillows supporting the head. Following spinal injection the woman is turned to an identical right lateral position. This is maintained until just before incision to minimise aorto-caval compression, when she is placed in the wedged supine position. Sixty women undergoing elective caesarean section were randomised to receive spinal anaesthesia using hyperbaric bupivacaine in either the Oxford (group O), or the sitting position followed immediately by the wedged supine position (group S). Ephedrine 6 mg was given every minute that systolic blood pressure was less than 80% of baseline. In group S, 9/30 women lost pinprick sensation up to T4 at 5 minutes compared with 2/30 in group O (chi2 test, P = 0.04). Block height was more variable in group S than in group O (f test, P = 0.001). Blood pressure decreased by a greater amount initially: group S women required more ephedrine (15.5 +/- 12.9 versus 9.2 +/- 7.7 mg, t test, P = 0.03). Block height with spinal anaesthesia for caesarean section is more predictable and haemodynamically stable if the Oxford position is used whilst anaesthesia develops.

Clinical Trial↗
PubMedDate not supplied

Postdural puncture headache after continuous spinal anesthesia with 18-gauge and 20-gauge needles.

BACKGROUND AND OBJECTIVES: To evaluate the incidence of postdural puncture headache (PDPH) associated with continuous spinal anesthesia, 200 male patients (mean age 65 years) were randomly assigned to receive spinal anesthesia in one of three ways: group 1, 50 patients with an 18-gauge Tuohy-Schliff needle/20-gauge catheter combination; group 2, 50 patients with a newly developed 20-gauge Quincke point needle/24-gauge catheter combination; and group 3, 100 patients (control group, single injection spinal anesthesia) with a 22-gauge Quincke point needle. METHODS: Every patient was followed up for 7 days postoperatively. RESULTS: The incidence of PDPH was 6% with each continuous technique and 2% in the control group (difference not statistically significant). One group 1 patient who required an initial dose of 35 mg of tetracaine and 100 mg of lidocaine has a persistent, incomplete S4-5 sensory nerve deficit. CONCLUSIONS: The incidence of PDPH associated with continuous spinal anesthesia is acceptable in appropriate clinical circumstances, but large initial doses of local anesthetic should not be administered.

Aged↗
PubMed1981

Blood concentration of lidocaine after spinal anaesthesia using lidocaine and lidocaine with adrenaline.

In 32 patients undergoing spinal anaesthesia with lidocaine or lidocaine plus adrenaline, the concentration of lidocaine base was measured in repeated venous blood samples. Half of the patients were given 100 mg lidocaine alone and the other half 100 mg lidocaine with the addition of 0.2 mg adrenaline. The blood concentration of lidocaine was significantly higher in the lidocaine group than in the group that received lidocaine with adrenaline. The mean maximal concentrations in these two groups lay between 0.2 and 0.3 and between 0.1 and 0.2 micrograms/ml, respectively (P less than 0.01). The time required for the individual maximal concentration to be reached was independent of whether the anaesthetic contained adrenaline or not. The blood concentration showed no correlation to body weight, height, or body surface area. In the first 60 min after the spinal injection the extent of the sensory block was the same in the two groups, but at 120 min this extent was significantly greater in the lidocaine-adrenaline group (P less than 0.01). The results show that the blood concentration of lidocaine is low in spinal anaesthesia compared with other types of regional anaesthesia.

Aged↗
PubMed2000

Differential effects of spinal (R)-ketoprofen and (S)-ketoprofen against signs of neuropathic pain and tonic nociception: evidence for a novel mechanism of action of (R)-ketoprofen against tactile allodynia.

The spinal activity of racemic ketoprofen and its enantiomers in models of neuropathic and tonic pain was explored in rats. Tactile allodynia and thermal hyperalgesia were induced by tight ligation of the L(5)/L(6) spinal nerves. Tonic pain was modeled by the formalin-induced flinch response. The spinal injection of (S)-ketoprofen alone or of morphine alone did not produce antiallodynic activity. A 1:1 combination of these drugs produced a robust dose-dependent antiallodynic action, consistent with previous observations where (S)-ketorolac combined with morphine also produced antiallodynia. (R)-ketoprofen given alone spinally produced a dose-dependent antiallodynia, but its activity was not augmented by spinal morphine. Conversely, (S)-ketoprofen, but not (R)-ketoprofen, blocked the second phase of the formalin-induced flinch response; neither enantiomer significantly blocked phase one of the formalin response. Again, (S)-, but not (R)-ketoprofen, interacted synergistically with spinal morphine in suppressing the phase II formalin response. These results are consistent with a spinal COX inhibitory action of (S)-ketoprofen. These results also point to a novel, as yet undefined, mechanism of action of (R)-ketoprofen against signs of neuropathic pain that does not appear to involve COX inhibition. The ability to modulate tactile allodynia is of special interest as this represents an aspect of clinical neuropathic pain that is very difficult to treat adequately.

Analgesics, Opioid↗
PubMed2001

Damage to the conus medullaris following spinal anaesthesia.

Seven cases are described in which neurological damage followed spinal or combined spinal-epidural anaesthesia using an atraumatic spinal needle. All patients were women, six obstetric and one surgical. All experienced pain during insertion of the needle, which was usually believed to be introduced at the L2-3 interspace. In all cases, there was free flow of cerebrospinal fluid before spinal injection. There was one patchy block but, in the rest, anaesthesia was successful. Unilateral sensory loss at the levels of L4-S1 (and sometimes pain) persisted in all patients; there was foot drop in six and urinary symptoms in three. Magnetic resonance imaging showed a spinal cord of normal length with a syrinx in the conus (n = 6) on the same side as both the persisting clinical deficit and the symptoms that had occurred at insertion of the needle. The tip of the conus usually lies at L1-2, although it may extend further. Tuffier's line is an unreliable method of identifying the lumbar interspaces, and anaesthetists commonly select a space that is one or more segments higher than they assume. Because of these sources of error, anaesthetists need to relearn the rule that a spinal needle should not be inserted above L3.

Adult↗
PubMed1990

Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs.

Twenty-four parturients undergoing elective Caesarean section were allocated randomly to have the legs wrapped with elasticated Esmarch bandages immediately following spinal anaesthesia or to serve as controls. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) was treated with i.v. ephedrine in 5-mg boluses. Leg wrapped patients had a significantly (P = 0.0033) lower incidence (16.7%) of hypotension than controls (83.3%). Only two patients in the leg wrapped group required ephedrine compared with 10 in the control group. Systolic arterial pressure was significantly (P less than 0.05) less in control subjects at 4, 5 and 6 min following spinal injection. No patient in the leg wrapped group became hypotensive following removal of the elasticated bandages.

Anesthesia, Obstetrical↗
PubMedDate not supplied

Wrapping of the legs reduces the decrease in blood pressure following spinal anesthesia. A study in men undergoing urologic procedures.

BACKGROUND AND OBJECTIVES: Hypotension after induction of spinal anesthesia remains a common and a potentially serious complication despite acute expansion of intravascular volume. The current study evaluated the role of leg wrapping as an adjunct to acute volume expansion. METHODS: Twenty-four men undergoing elective urologic procedures were randomly assigned to two groups. Patients in the experimental group had their legs wrapped tightly while those in the control group had their legs wrapped loosely with elastic bandages immediately following spinal anesthesia. Significant hypotension was defined as a decrease in mean arterial pressure to less than 65 mm Hg. RESULTS: Systolic blood pressure was significantly lower (P < .05) in the control group at 4, 5, 7, 9, 10, 12.5, and 15 minutes following spinal injection. Diastolic blood pressure was significantly lower (P < .05) in control subjects at 7, 8, 10, and 15 minutes following the block. None of the patients in either group became hypotensive following removal of the elasticized bandages. CONCLUSIONS: Tightly wrapping the legs with elastic bandages immediately after placing spinal anesthesia in mature men is a safe and efficient adjunct in preventing hypotension.

Aged↗
PubMed1997

Parallel medullary gustatospinal pathways in a catfish: possible neural substrates for taste-mediated food search.

Taste and tactile fibers in the facial nerve of catfish innervate extraoral taste buds and terminate somatotopically in the facial lobe (FL)-a medullary structure crucial for gustatory-mediated food search. The present study was performed to determine the neural linkages between the gustatory input and the spinal motor output. Spinal injections of horseradish peroxidase (HRP) label spinopetal cells in the octaval nuclei, the nucleus of the medial longitudinal fasciculus, and reticulospinal neurons (Rsps) in the brainstem medial reticular formation (RF), including the Mauthner cell. A somatotopically organized, direct faciospinal system originating from superficial cells scattered in the lateral lobule of the facial lobe (ll) is also labeled. The brainstem reticulospinal cells are segmentally organized into 14 clusters within eight segments of the reticular formation and includes one cluster (RS5) directly ventral to the FL. Injections of HRP or fluorescent tracers into the medial lobule of the FL label a facioreticular projection terminating around the Rsps of RS5. DiI injections into this area of the RF retrogradely label deeply situated bipolar neurons, especially in the medial and intermediate lobules of the FL. Electrophysiological recordings in and around RS5 show units with large receptive fields and with responses to chemical and tactile stimulation. The FL projects to the spinal cord via two pathways: (1) a topographically organized direct faciospinal pathway, and (2) an indirect facioreticulospinal pathway in which reticular neurons process and integrate gustatory information before influencing spinal circuitry for motor control during food search.

Animals↗
PubMed2001

Spinal anesthesia with tetracaine in 7.5% or 0.75% glucose in adolescents and adults.

UNLABELLED: To examine whether adolescents and adults might develop different anesthetic distribution and hemodynamic consequences after spinal injection of 0.5% tetracaine in 7.5% or 0.75% glucose, we studied 100 ASA I or II patients who were scheduled for elective surgery to the lower limb and fulfilled the following criteria: age between 13 and 16 yr (Adolescent group, n = 40) or between 25 and 74 yr (Adult group, n = 60); height between 155 and 180 cm; and body mass index between 18 and 32 kg/m(2). Patients in each group were then randomly divided into two equal subgroups to receive spinal anesthesia with 0.5% tetracaine in either 7.5% or 0.75% glucose with 0.125% phenylephrine at the L3-4 interspace. With patients in the supine horizontal position, neural block was assessed by cold, pinprick, and touch sensation and a modified Bromage scale after the injection of the study drug. The 7.5% glucose solution produced a significantly higher and faster spread of blockade in adolescents than in adults. In contrast, there were no differences in the levels of three sensory modalities between the two age groups after the 0.75% glucose solution, which produced a lower spread of blockade than the 7.5% glucose solution in either age group. Adolescents given the 0.75% glucose solution developed a smaller maximum decrease in systolic pressure than those given the heavier solution. We conclude that adolescents may develop an extensive level of blockade more easily and quickly than adults after intrathecal hyperbaric tetracaine, but that the difference may be reduced by using a less heavy solution. IMPLICATIONS: The influence of age on the characteristics of spinal anesthesia is still controversial. Our results show that adolescents develop blockade more extensively and quickly than adults after spinal anesthesia with 0.5%tetracaine in 7.5% glucose but not after the 0.75% glucose solution.

Adolescent↗
PubMedDate not supplied

Sympathetic block during spinal anesthesia in volunteers using lidocaine, tetracaine, and bupivacaine.

BACKGROUND AND OBJECTIVES: Spinal anesthesia to high thoracic dermatomes is alleged to result in almost complete block of all sympathetic efferent nerves. To examine the degree of sympathectomy during spinal anesthesia, the sympathetic response to a cold pressor test (CPT) applied to unblocked dermatomes before and during spinal anesthesia was measured with use of three different local anesthetics. METHODS: Twelve healthy volunteers were studied in a randomized and double-blind fashion on three separate occasions. In random order, each volunteer received approximately equipotent spinal doses of tetracaine 15 mg, bupivacaine 15 mg, and lidocaine 100 mg in hyperbaric solutions. Prior to and 30 minutes after spinal injection of local anesthetic, a CPT was applied for 2 minutes, and changes from baseline resting conditions in five physiologic variables were measured. RESULTS: The CPT 1 given before anesthetic administration resulted in an increase in heart rate, mean arterial pressure, cardiac index, and plasma concentrations of norepinephrine and epinephrine. Spinal anesthesia to a median level of T3 resulted in a decrease in mean arterial pressure by 10-12% but did not significantly decrease the other variables. Spinal anesthesia did not change the increase in heart rate or cardiac index in response to the second CPT, but the increase in mean arterial pressure was attenuated compared to the CPT before anesthesia. No increase in norepinephrine or epinephrine concentration was observed during the CPT given during spinal anesthesia. There was no significant relationship between level of analgesia and sympathetic response to stress. CONCLUSIONS: Spinal anesthesia with hyperbaric solutions of tetracaine 15 mg, bupivacaine 15 mg, and lidocaine 100 mg attenuated sympathetic function but did not produce complete sympathectomy. The effects were independent of the local anesthetic used.

Adult↗
PubMed1979

Fuorescent retrograde neuronal labeling in rat by means of substances binding specifically to adenine-thymine rich DNA.

Six fluorescent substances, binding specifically to adenine-thymine rich DNA, were injected in rat caudate-putamen. This resulted in retrograde axonal transport and fluorescent retrograde labeling of neurons in center-medium parafascicular nucleus, substantia nigra and dorsal raphe. Two of these substances, i.e. "True Blue' and 'Granular Blue', give a very striking blue fluorescent retrograde neuronal labeling. Mid-thoracic spinal injections of these two substances in rat also resulted in a pronounced retrograde fluorescent labeling of neurons of the descending brainstem pathways and of neurons in the sensori-motor cortex.

Adenine↗
PubMed1995

The influence of aging on skin temperature and hemodynamic changes during spinal anesthesia.

We investigated the influence of aging on the relationship between arterial pressure and skin temperature as a simple and indirect indicator of cutaneous blood flow. Sole and palm skin temperatures, sublingual temperature, heart rate, mean arterial blood pressure (MAP), and the anesthetic level as determined by cold discrimination, were measured before and during minor surgery under spinal anesthesia in patients under 65 years (young group) and above 65 years (elderly group). The sole skin temperature (Tsole) started to increase in the young group whose anesthesia level reached above L1-L2, and approached the sublingual temperature in those whose anesthesia level reached above T8-T10 after spinal injection. There was, however, no relationship between the anesthesia level and Tsole in the young group. The change in Tsole was less in elderly patients than that in young patients with the same decrease in MAP. These findings suggest that a decrease in peripheral resistance may not be the main cause of hypotension during spinal anesthesia in elderly patients.

Adult↗
PubMed2004

Fluoroscopically guided caudal epidural steroid injections for lumbar spinal stenosis: a restrospective evaluation of long term efficacy.

BACKGROUND: Degenerative lumbar spinal stenosis is a frequent cause of disability in the elderly population. Epidural steroid injections are a commonly used conservative modality in the treatment of patients with degenerative lumbar spinal stenosis. Relatively few studies have specifically addressed the efficacy of epidural steroid injections for spinal stenosis, with success rates varying from 20% to 100%. OBJECTIVE: To assess the efficacy of fluoroscopically guided caudal epidural steroid injections in the management of degenerative lumbar spinal stenosis. DESIGN: Retrospective chart review and follow-up study. METHODS: All the patients who had undergone at least one fluoroscopically guided caudal epidural steroid injection between 1995 and 2002 were reviewed. All of the caudal epidural steroid injections were done with fluoroscopic guidance. MAIN OUTCOME MEASURES: Visual Numeric Scale (VNS), Roland-Morris Disability Questionnaire (RMDQ), North American Spine Society Patient Satisfaction Index (NASS), and subsequent surgery. RESULTS: Ninety-five patients selected from chart review met inclusion criteria. Eighty (84%) completed the follow-up questionnaire by mail or telephone interview. Patients received an average of 1.6 epidural steroid injections. Twelve patients subsequently underwent surgical procedures. A VNS improvement of 50% or greater was seen in 35% of patients. A functional improvement of 2 points or greater was seen on the RMDQ in 36% of patients. Long-term success of treatment was seen in 35% of patients. The concurrent presence of degenerative spondylolisthesis was the only variable which was found to have a significant positive correlation with successful outcomes (P < 0.009). CONCLUSION: Caudally placed fluoroscopically guided epidural steroid injections offered a safe, minimally invasive option for managing pain caused by lumbar spinal stenosis. The concurrent presence of degenerative spondylolisthesis appears to be an independent positive prognostic factor for successful outcome.

Journal Article↗
PubMed2001

The effects of benzodiazepines on human opioid receptor binding and function.

UNLABELLED: We performed in vitro studies to investigate the potential interaction of benzodiazepines with cloned human opioid receptor subtypes. Midazolam, chlordiazepoxide, and diazepam directly displaced [(3)H]-diprenorphine binding from kappa and delta receptors, but not mu receptors, whereas flumazenil was inactive. These benzodiazepines also stimulated (35)S-GTPgammaS binding in membranes containing human kappa receptors, and the effect of midazolam was prevented by a selective kappa antagonist. Midazolam was also weakly active at delta-receptor activation, whereas all three were inactive at mu receptors. The results suggest that the analgesic efficacy reported for intrathecal benzodiazepines may be attributed, in part, to direct interaction with kappa-opioid receptors. IMPLICATIONS: Several human and animal studies have shown analgesic effects of benzodiazepines after spinal injection. Our results show that large concentrations of midazolam, chlordiazepoxide, and diazepam displace the binding of [(3)H]-diprenorphine-an opiate radioligand from kappa receptors. In an in vitro functional assay, midazolam is a weak agonist at the delta-opioid receptor, whereas all three benzodiazepines are kappa-opioid agonists. These findings may partially explain the mechanism of benzodiazepine-induced spinal analgesia.

Animals↗
PubMed1986

Immersion anesthesia for extracorporeal shock wave lithotripsy. Review of two hundred twenty treatments.

Two hundred twenty extracorporeal shockwave lithotripsy (ESWL) treatments at the New York Hospital-Cornell Medical Center between September, 1984, and April, 1985, were reviewed with respect to anesthetic management. One hundred seventy-four treatments (79%) were performed under a regional anesthetic technique (RA), either with an indwelling epidural catheter (155 treatments), or with a single spinal injection (19 treatments). Forty-six treatments (21%) were performed under general anesthesia (GA). Ninety per cent of the patients were classified as ASA I or II. Hypotension during treatment, defined as blood pressure falls greater than 20 per cent of baseline mean arterial pressure, was recorded with 19.5 per cent of the regional anesthetic treatments (18.7% of the epidurals and 26.3% of the spinals) and 13.0 per cent of the general anesthetic treatments. Blood pressure falls were larger in the regional group than in the general group. The average recovery room stay was longer for the bupivacaine (0.25-0.5%) epidurals and the tetracaine (0.4%) spinals (252 min and 212.1 min, respectively) than for the lidocaine (1.5-2.0%) epidurals and the general anesthetics (101.7 min and 102.1 min, respectively). General anesthesia, with controlled ventilation, was advantageous in minimizing renal excursion and stone movement during treatment. Yet, in appropriately selected and sedated patients, regional anesthesia with continuous lidocaine epidural techniques was found to provide acceptable anesthesia for patients undergoing ESWL.

Adolescent↗
PubMed1999

Inhibition of baroreflex vagal bradycardia by selective stimulation of arterial chemoreceptors in rats.

We reported recently that hypoxia inhibits baroreflex vagal bradycardia (BVB) in rats and that this inhibition persists following chemoreceptor denervation. However, since it is possible that hypoxia also affects the central processing of chemoreceptive input, the existence of chemoreceptor-mediated inhibition of BVB cannot be ruled out. Therefore, we have studied whether selective chemoreceptor activation affects BVB in normoxic conditions. In pentobarbital-urethane-anaesthetized, succinylcholine-immobilized, artificially ventilated rats, BVB was provoked by electrical stimulation of the aortic depressor nerve. Arterial chemoreceptors were selectively activated by intracarotid injection of a minute amount of sodium cyanide. Cyanide injection consistently increased blood pressure while changing heart rate variably. BVB was inhibited in a dose-dependent manner. This inhibition, as well as changes in blood pressure and heart rate, was abolished following transection of the carotid sinus nerve (CSN) ipsilateral to the injection. Spinal cord transection at the C2 level did not affect the inhibition. On the other hand, intracarotid cyanide had no effect on bradycardia elicited by electrical stimulation of a peripheral cut end of the cervical vagus nerve. We conclude that chemoreceptor activation definitely inhibits BVB and that this inhibition is mediated by the CSN, and predominantly occurs in the central nervous system. The possibility is suggested that severe hypoxia suppresses not only BVB but also the chemoreceptor-mediated inhibition of BVB, both via the direct, central action.

Afferent Pathways↗