• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.26 no.2
• /
• pp.130-140
• /
• 2024

Objective: To assess whether local anesthetic infiltration could minimize the carotid baroreceptor reflex (CBR) which has an incidence after carotid artery stenting (CAS) that varies from 29% to 51%. Methods: This retrospective single-center study included 51 patients (mean age, 70.47 years) who underwent CAS for carotid stenosis. The groups included patients who underwent CAS for asymptomatic ischemic stroke (n=41) or symptomatic disease (n=10). Preprocedural percutaneous lidocaine injections (PPLIs) were administered to 70.6% and 5.9% of patients who underwent elective CAS and emergency CAS, respectively. Results: Among patients who received PPLIs, the mean degree of stenosis was 80.5% (95% confidence interval [CI]: ±10.74, 51-98%). The mean distance from the common carotid artery bifurcation to the most stenotic lesion (CSD) was 8.3 mm (95% CI: ±0.97, 6.3-10.2 mm); the mean angle between the internal carotid artery and common carotid artery (CCA) trunk (IAG) was 65.6° (95% CI: ±2.39, 61-70°). Among patients who did not receive PPLIs, the mean degree of stenosis was 84.0% (95% CI: ±8.96, 70-99%). The mean CSD was 5.9 mm (95% CI: ±1.83, 1.9-9.9 mm); the mean IAG was 60.4° (95% CI: ±4.41, 51-70°). The procedure time was longer in the PPLI group than in the no PPLI group (28.19 [n=39] vs. 18.88 [n=12] days) (P=0.057); the length of intensive care unit stay was shorter in the PPLI group (20.01 [n=36] vs. 28.10 [n=5] days) (P=0.132). Conclusions: Targeted PPLI administration to the carotid bulb decreased aberrant heart rates and blood pressure changes induced by carotid stent deployment and balloon inflation. As CBR sensitivity increases with decreasing distance to the stenotic lesion from the CCA bifurcation, PPLIs may help stabilize patients during procedures for stenotic lesions closer to the CCA.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.21 no.1
• /
• pp.61-69
• /
• 2021

Background: Inferior alveolar nerve block (IANB) using lidocaine 2% is commonly used for anesthetizing primary mandibular molars; however, this technique has the highest level of patient discomfort compared to other local anesthesia techniques. Therefore, alternative anesthesia techniques are necessary. The aim of this study was to evaluate the efficacy of a single buccal infiltration of 4% articaine with IANB using 2% lidocaine, for the bilateral extraction of primary mandibular molars. Methods: The present study was conducted on 30 patients aged between 6 and 9 years, who required the extraction of bilateral primary mandibular molars. The patients were randomly divided into two groups as follows: In the first session, Group A received IANB with lidocaine 2% and group B received infiltration with articaine 4%. In the second session, another injection method was performed on the opposite side. The Wong-Baker Facial Pain scale (WBFPS), Face Leg Activity Cry, and Consolability (FLACC), and physiologic parameters were used to assess pain perception. Results: The independent t-test showed no statistically significant difference in blood pressure and heart rate before and after extraction (P > 0.05). The mean FLACC index in the lidocaine and articaine groups was 0.89 and 1.36, respectively; there was no statistically significant difference between them (P > 0.05). According to the results of the chi-square test, there was no statistically significant difference between the groups for WBFPS (P > 0.05). Conclusion: The articaine infiltration technique may be an alternative to the IANB for the extraction of primary mandibular molars.

• The Korean Journal of Physiology and Pharmacology
• /
• v.2 no.3
• /
• pp.297-305
• /
• 1998

This study used in vivo intracellular recording in rat hippocampus to evaluate the effect of lidocaine and MK-801 on the membrane properties and the synaptic responses of individual neurons to electrical stimulation of the commissural pathway. Cells in control group typically fired in a tonic discharge mode with an average firing frequency of $2.4{\pm}0.9$ Hz. Neuron in MK-801 treated group (0.2 mg/kg, i.p.) had an average input resistance of $3.28{\pm}5.7\;M{\Omega}$ and a membrane time constant of $7.4{\pm}1.8$ ms. These neurons exhibited $2.4{\pm}0.2$ ms spike durations, which were similar to the average spike duration recorded in the neurons of the control group. Slightly less than half of these neurons were firing spontaneously with an average discharge rate of $2.4{\pm}1.1$ Hz. The average peak amplitude of the AHP following the spikes in these groups was $7.4{\pm}0.6$ mV with respect to the resting membrane potential. Cells in MK-801 and lidocaine treated group (5 mg/kg, i.c.v.) had an average input resistance of $3.45{\pm}6.0\;M{\Omega}$ and an average time constant of $8.0{\pm}1.4$ ms. The cells were firing spontaneously at an average discharge rate of $0.6{\pm}0.4$ Hz. Upon depolarization of the membrane by 0.8 nA for 400 ms, all of the tested cells exhibited accommodation of spike discharge. The most common synaptic response contained an EPSP followed by early-IPSP and late-IPSP. Analysis of the voltage dependence revealed that the early-IPSP and late-IPSP were putative $Cl^--and\;K^+-dependent$, respectively. Systemic injection of the NMDA receptor blocker, MK-801, did not block synaptic responses to the stimulation of the commissural pathway. No significant modifications of EPSP, early-IPSP, or late-IPSP components were detected in the MK-801 and/or lidocaine treated group. These results suggest that MK-801 and lidocaine manifest their CNS effects through firing pattern of hippocampal pyramidal cells and neural network pattern by changing the synaptic efficacy and cellular membrane properties.

• The Korean Journal of Physiology and Pharmacology
• /
• v.7 no.3
• /
• pp.119-124
• /
• 2003

To elucidate the molecular mechanism of pharmacological action of local anesthetics, we studied membrane actions of tetracaine, bupivacaine, lidocaine, prilocaine and procaine. Fluorescence polarization of n-(9-anthroyloxy)stearic acid (n-AS) was used to examine the effects of these local anesthetics on differential rotational mobility of different positions of the number of synaptosomal plasma membrane vesicle (SPMV) phospholipid carbon atoms. The four membrane components differed with respect to 3, 6, 9 and 16-(9-anthroyloxy)stearic acid (3-AS, 6-AS, 9-AS and 16-AP) probes, indicating that differences in the membrane fluidity might be present. Degrees of the rotational mobility of 3-AS, 6-AS, 9-AS and 16-AP were different depending on depth of hydrocarbon interior. In a dose-dependentmanner, tetracaine, bupivacaine, lidocaine, prilocaine and procaine decreased anisotropy of 3-AS, 6-AS, 9-AS and 16-AP in the hydrocarbon interior of the SPMV. These results indicate that local anesthetics have significant disordering effects on hydrocarbon interior of the SPMV, thus affecting the transport of $Na^+$ and $K^+$ in nerve membranes and leading to anesthetic action.

• The Korean Journal of Physiology and Pharmacology
• /
• v.1 no.6
• /
• pp.603-611
• /
• 1997

The motor evoked potentials (MEPs) have been advocated as a method of monitoring the integrity of spinal efferent pathways in various injury models of the central nervous system. However, there were many disputes about origin sites of MEPs generated by transcranial electrical stimulation. The purpose of present study was to investigate the effect of major extrapyramidal motor nuclei such as lateral vestibular nucleus (VN) and medullary reticular nucleus (mRTN) on any components of the MEPs in adult Sprague-Dalwey rats. MEPs were evoked by electrical stimulation of the right sensorimotor cortex through a stainless steel screw with 0.5mm in diameter, and recorded epidurally at T9 - T10 spinal cord levels by using a pair of teflon-coated stainless steel wire electrodes with 1mm exposed tip. In order to inject lidocaine and make a lesion, insulated long dental needle with noninsulated tips were placed stareotoxically in VN and mRTN. Lidocaine of $2{\sim}3\;{\mu}l$ was injected into either VN or mRTN. The normal MEPs were composed of typical four reproducible waves; P1, P2, P3, P4. The first wave (P1) was shown at a mean latency of 1.2 ms, corresponding to a conduction velocity of 67.5 m/sec. The latencies of MEPs were shortened and the amplitudes were increased as stimulus intensity was increased. The amplitudes of P1 and P2 were more decreased among 4 waves of MEPs after lidocaine microinjection into mRTN. Especially, the amplitude of P1 was decreased by 50% after lidocaine microinjection into bilateral mRTN. On the other hand, lidocaine microinjection into VN reduced the amplitudes of P3 and P4 than other MEP waves. However, the latencies of MEPs were not changed by lidocaine microinjection into either VN or mRTN. These results suggest that the vestibular and reticular nuclei contribute to partially different role in generation of MEPs elicited by transcranial electrical stimulation.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.9 no.2
• /
• pp.105-108
• /
• 2011

Aconitine is an anti-inflammatory agent with therapeutic uses in oriental medicine as an analgesic and for treatment of stroke. Because of its sodium channel effect, aconitine can promote undesirable, wide complex tachyarrhythmia. If tachycardia develops during use of aconitine, class Ia and class III anti arrhythmic drugs can be utilized for treatment. However there are no single anti-arrhythmia agents which are uniformly effective. We report a case, characterized by wide complex tachyarrhythmia and severe hypotension, which was successfully treated by simultaneous injections of amiodarone and lidocaine. A 59-year-old woman exhibiting clinical signs of drowsiness as a result of ingesting 6 g of aconitine, was admitted to the emergency department. Initially, wide complex tachyarrhythmia (ventricular tachycardia and pulse rate of 180 beats/min) and severe hypotension (blood pressure of 53/26 mmHg) was observed. After simultaneous injection of amiodarone and lidocaine, the patient's rhythm pattern changed to an accelerated junctional rhythm with ventricular premature complex. Two hours later, the patient's heart pattern became a sinus rhythm. As demonstrated by this case, simultaneous injections of amiodarone and lidocaine can be useful in treating ventricular arrhythmia induced by aconitine.

• Clinics in Shoulder and Elbow
• /
• v.24 no.1
• /
• pp.4-8
• /
• 2021

Background: As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs. Methods: Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation. Results: Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671). Conclusions: Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.21 no.1
• /
• pp.49-59
• /
• 2021

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).

• Journal of the Korean Academy of Clinical Electrophysiology
• /
• v.2 no.1
• /
• pp.39-48
• /
• 2004

The study was to determine the effect of local anesthetics phonophoretic. Emla 5%(lidocaine+prilocaine) cream make use of medicines. Phonophoretic the application of a ultra sound(I group), application an ointment(II group). Forty college student between the age of man $22.85{\pm}3.31$ woman $21.05{\pm}2.12$, weight of man $70.70{\pm}9.43\;kg$ woman $50.65{\pm}5.13\;kg$, height of man $17.6{\pm}5.43\;cm$ woman $161.20{\pm}4.34\;cm$ were in this study. The results was as follows. There was statistical difference between I group($49.25{\pm}10.83$) and II group($58.90{\pm}10.83$) for the timing of local anesthetics(p<.05).

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.2 no.1
• /
• pp.13-17
• /
• 2009

Purpose: The purpose of this study was to know the cause of the tenderness at pes anserinus. Materials and Methods: Out of 24 patients with tenderness at pes anserinus, 23 patients were female and 1 patient was male, and their average age was 65.9 years old. We checked the tenderness at pes anserinus by history taking & physical examniation and then, checked the pes anserinus for the presence of bursitis by US in outpatient clinic. With no evidence of bursitis by US, we injected steroid-lidocaine mixture intraarticularly and checked whether the tenderness disappeared after 2~3 minutes. Results: There was no case with bursitis at pes anserinus by US. The tenderness at pes anserinus diminished in 2-3 minutes after the intraarticular injection of the steroid-lidocaine mixture. After 6 weeks follow up, 16 patients(66.7%) had little or no tenderness at pes anserinus. 8 cases had the recurrence of tenderness recurred, 4 cases underwent arthroscopic operation on the meniscal tear, and 1 case underwent total knee arthroplasty. All cases underwent any operations had the tenderness at pes anserinus disappeared. The others 3 cases did not undergo total knee arthroplasty despite of radiologic obliteration of knee joint adequate for Kellgren-Lawrence grade IV. Conclusion: Without the bursitis at Pes Anserinus, patients the osteoarthritis may have the tenderness due to the referred pain.