• 대한임상독성학회지
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• 제11권1호
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• pp.23-27
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• 2013

Zoletil is a non-opioid, non-barbiturate animal anesthetic and proprietary combination of two drugs, a dissociative anesthetic drug, tiletamine, with the benzodiazepine anxiolytic drug, zolazepam. Zoletil has greater potency than ketamine. Zoletil is abused for recreational purposes, especially by people with easy access to medicine. However, in Korea, it is available over-the-counter. Here we report on a case of an 83-year-old woman who received injection of seven vials of "Zoletil 50" by her daughter and presented with an altered mental change. Her mental state was stupor and vital sign was hypotension, bradycardia. Her blood tests indicated metabolic and respiratory acidosis and hyperkalemia. She was treated with intravenous naloxone and flumazenil but was not responsive. She was admitted to the ICU and treated with supportive therapy. Her mental state showed transient recovery, however, her clinical manifestation worsened and she expired.

• The Korean Journal of Pain
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• 제8권2호
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• pp.244-250
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• 1995

Many clinical and laboratory experiments have been developed to prevent or decrease post-operative pain. One of these methods is pre-operative administration of opioid. Recently there have been differing and debatable results reported of pre-operative treatment for post-operative pain management. It was our study to determine whether pre-operative epidural fentanyl prevented central facilitation or wind up of spinal cord from nociceptive afferent input through c-fibers. We evaluated the effect of epidural fentanyl 50 mcg 10 minutes before operation and 10 minutes before the end of surgery. 28 parturient women for Cesarean Section were randomly allocated to receive the epidural fentanyl either at 10 minutes before operation (Group 1, n=14) or 10 minutes before the end of surgery (Group 2, n=14). All of the 28 parturient women were anesthetized with epidural block using (22 ml of) 2% lidocaine supplemented with light general anesthesia ($N_2O$ 2 L/min-$O_2$, 2 L/min), we controlled post-operative pain with epidural PCA(patient controlled analgesia) infusion of meperidine and 0.07% bupivacaine. The action duration of epidural fentanyl from the end of surgery to the first requirement of analgesics with epidural PCA were not significantly different between the two groups. No significant differences between two groups were observed in VAS pain score at 1, 2, 3, 6, 12, 24, and 48 hours after the operation. The number of self administration of narcotics with PCA during 48 hours after surgery were the same between the two groups. The hourly infusion rates of demerol were the same. Pre-operative administration of fentanyl was not clinically effective compared to administration just before the end of surgery for postoperative pain control.

• 한국식품영양과학회:학술대회논문집
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• 한국식품영양과학회 2001년도 International Symposium on Food,Nutrition and Health for 21st Century
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• pp.69-73
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• 2001

Two opioid peptides, YPLDL and YPLDLF, were isolated from enzymatic digests of spinach ribulose-1, 5-bisphosphate carboxylase/oxygenase (RuBisCO) and named rubiscolin-5 and -6, respectively. These peptides were selective for delta-receptor and the latter was about 3 times more potent than the former. After oral administration in mice at the dose of 100 mg/kg, rubiscolin-6 showed analgesic activity in tail pinch test. It also stimutated learning performance at the same dose in passive avoidance experiment using step-through apparatus. An immunostimulating peptide, MITLAIPVNKPGR, was isolated from a trypsin digest of soybean protein and named soymetide. Immunostimulating activy of soymetide was mediated by fMLP receptor. Interestingly, after oral administration in rats at a dose of 300 mg/kg (po.), soymetide-4 (MITL) protected alopecia (hair-loss) induced by etoposide, a cancer chemotherapy agent. Stimulation of IL-1 release by the peptide was involved in the mechanism. Ovokinin(2-7), RADHPF, is a vasorelaxing peptide released from ovalbumin by the action of chymotrypsin. It lowered blood pressure of spontaneously hypersensive rats (SHR) after oral administration at a dose of 10 mg/kg. RPLKPW, which was designed by replacing 4 amino acid residues in ovokinin(2-7), exhibited hypotensive activity at a dose of 0.1 mg/kg (po.). This peptides was introduced into 3 homologous sites in soybean beta-conglycinin alpha' subunit by site-directed mutagenesis of the cDNA and expressed in E. coli. The minimum effective dose for hypotensive activity of the genetically modified beta-conglycinin alpha' subunit was 10 mg/kg (po.), which is about 1/200 that of ovalbumin.

• Journal of Acupuncture Research
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• 제23권5호
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• pp.39-54
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• 2006

Objectives : Herniation of Nucleus Pulpous (HNP) of Lumbar is one of the most common causes of low back pain. The aim of this study is to investigate the effectiveness of acupuncture, bee venom acupuncture (BVA), and bee venom Pharmacopuncture (BVP) therapy for HNP. Methods : We separated 35 patients with HNP of L-spine into three groups; Acupuncture treated group, BVA treated group, and BVP treated group, and monitored for 30 days. 4 grades of recovery degree, score of Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) were examined for comparison. Results : 1. Visual Analogue Scale of low back pain and radiating pain showed significant decrease in BVA and BVP groups compared to the Acupuncture group at VAS0_2, VAS0_3 evaluations. 2. ODI of disability of daily activities showed significant decrease in BVA and BVP groups compared to the Acupuncture group at VAS0_1, VAS0_2, and VAS0_3 evaluations. 3. Compared to the Acupuncture group, BVA and BVP groups were improved in S.L.R.T and R.O.M of L-spine as confirmed by the physical examination. 4. Treatment efficacy was more apparent in acute cases as ODI was significantly lower than chronic cases. Conclusion : BVA and BVP therapies can be used in addition to the acupuncture therapy for highly effective treatment of HNP. Further clinical studies are required to verify these findings.

• Journal of Acupuncture Research
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• 제18권6호
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• pp.215-224
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• 2001

Objcetive : Neuropathic pain sometimes arises from a partial peripheral nerve injury. This kind of pain is usually accompanied by spontaneous burning pain, allodynia and hyperalgesia. It has been well known that acupuncture is effective to the pain control from ancient time in Asia. However, it is not clear whether acupuncture can control neuropathic pain. The aim of the present study is to examine if acupuncture stimulation may be effective to the mechanical allodynia in a rat model of neuropathic pain. Methods : To produce neuropathic pain, under sodium pentobarbital anesthesia, the right superior caudal trunk was resected between the S3 and S4 spinal nerves. After the neuropathic surgery, we examined if the animals exhibited the behavioral signs of mechanical allodynia. The mechanical allodynia was assessed by stimulating the tail with von Frey hair (bending force : 2.0g). three or 6 weeks after the neuropathic surgery, acupuncture stimulation was delivered to Houxi (SI 3) as the following parameters (2HZ frequency, 0.07mA intensity and 3msec duration) for 30 minutes. Results : The stimulation of Houxi (SI 3) acupoint relieved the behavioral signs of mechanical allodynia. Conclusion : Our results suggest that acupuncture can control the mechanical allodynia of neuropathic pain.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권1호
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• pp.47-56
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• 2018

Background: The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry. Methods: A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences. Results: A total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P < 0.001), and a decrease in procedural recollection immediately following the procedure (P = 0.03), and 24 to 48 hours later (P = 0.009). Administering fentanyl first required an average of 2.43 mg (29%) less midazolam (P < 0.001). No significant differences were found for change in vital signs, minimum oxygen saturation levels, recovery times, and patient satisfaction (P > 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group. Conclusions: The administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.

• Bulletin of the Korean Chemical Society
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• 제31권4호
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• pp.874-880
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• 2010

A series of 13- and 14-membered cyclic enkephalin analogs based on the moderately $\mu$ selective prototype compound Tyr-C[D-$A_2bu$-Gly-Phe-Leu] 8a were synthesized to investigate the structure-activity relationship. The modifications of sequence were mainly focused on two positions 3 and 5, critical for the selective recognition for $\mu$ and $\delta$ opioid receptors. The substitution of hydrophobic $Leu^5$ with hydrophilic $Asp^5$ derivatives led to Tyr-C[D-$A_2bu$-Gly-Phe-Asp(N-Me)] 7 and Tyr-C[D-Glu-Phe-gPhe-rAsp(O-Me)] 5, the peptides with a large affinity losses at both $\mu$ and $\delta$ receptors. The substitution of $Phe^3$ with $Gly^3$ led to Tyr-C[D-Glu-Gly-gPhe-rLeu] 3 and Tyr-C[D-Glu-Gly-gPhe-D-rLeu] 4, the peptides with large affinity losses at $\mu$ receptors, indicating the critical role of phenyl ring of $Phe^3$ for $\mu$ receptor affinities. One atom reduction of the ring size from 14-membered analogs Tyr-C[D-Glu-Phe-gPhe-(L and D)-rLeu] 6a, 6b to 13-membered analogs Tyr-C[D-Asp-Phe-gPhe-(L and D)-rLeu] 1, 2 reduced the affinity at both $\mu$ and $\delta$ receptors, but increased the potency in the nociceptive assay, indicating the ring constrain is attributed to high nociceptive potency of the analogs. For the influence of D- or L-chirality of $Leu^5$ on the receptor selectivity, regardless of chirality and ring size, all cyclic diastereomers displayed marked $\mu$ selectivity with low potencies at the $\delta$ receptor. The retro-inverso analogs display similar or more active at $\mu$ receptor, but less active at $\delta$ receptor than the parent analogs.

• Journal of Ginseng Research
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• 제22권1호
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• pp.43-50
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• 1998

We demonstrated in previous study that protopanaxadiol and protopanxatriol saponins show antinociceptive activity in acetic acid induced writhing test and in the second phase (11-40 min) of formalin test but not tail-flick test. To identify further which ginsenoside has antinociceptive activity among various ginseng saponins, we have investigated antinociceptive effects of several ginsenosides using writhing and formalin test. Ginsenoside Rc, Rd, Re, and Rf induced antinociception in writhing test. These four ginsenosides also induced antinociception in the second phase of formalin (11-40 min) test but these ginsenosides showed a slight antinociception in the first phase (010 min) of formalin test except ginsenoside Rf. The antinociceptive effects induced by the ginsenosides were dose dependent and were not blocked by an opioid receptor antagonist, naloxone. The order of antinociceptive potency was Rd > Rc > Re > Rf in the formalin test. However, these ginsenosides did not show any significant analgesic effects in a tail-flick test. These results suggest that ginsenosides such as Rc, Rd, Re, and Rf inhibit tonic pain rather than acute pain induced by noxious heat. These results also indicate that the antinociceptive activity. Induced by ginsenosides may be one of the actions for pharmacological effects of Panax ginseng.

• Journal of Acupuncture Research
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• 제27권5호
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• pp.13-24
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• 2010

Objectives : This study was designed to investigate the effects of bee venom acupuncture at Shinsu($BL_{23}$) and Daejangsu($BL_{25}$) on neuropathic pain induced by tibial and sural nerve injury in rats. Methods : Neuropathic pain model was made by partial resection of tibial and sural nerve. Three weeks after the neuropathic surgery, bee venom acupuncture was firstly injected at $BL_{23}$ and $BL_{25}$, then we measured withdrawal responses induced by von Frey filament and acetone stimulation. Bee venom acupunctures were injected 6times on every 2days. Measurement of withdrawal responses were conducted on the same days. After bee venom acupuncture injection, expression levels of c-Fos, nocieptin and KOR-3 were observed through using immunohistochemistry. Results : In this experiment, bee venom acupunctures at $BL_{23}$ and $BL_{25}$ decreased levels of withdrawal responses induced by von Frey filament and acetone stimulation respectively. In addtion, expression levels of c-Fos, nociceptin and KOR-3 in central gray part of brain in rats were decreased by bee venom acupuncture. Conclusions : These results imply that bee venom acupuncture was useful to treat patients with neuropathic pain, and related mechanisms were involved in opioid and their receptors such as nociceptin and KOR-3.

• 대한약침학회지
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• 제12권2호
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• pp.67-75
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• 2009

Objectives : This study was performed to developing orally administered analgesics and locally injected pharmacopuncture analgesics like opioids. Methods : Literary investigation on the origin of poppy (Papaver somniferum L) and other narcotics was conducted to examine the potential of developing orally administered analgesics and locally injected pharmacopuncture analgesics. Opium is a gum-like mass derived from air-dried white fluid of immature fruit of the poppy. Opium contains approximately 20 types of alkaloids including morphine, codeine, thebaine, papaverine and others. Natural opioids and synthetic alkaloid derivatives are the constituents of opioid analgesics and their effects and side-effects depend on the peculiarities of receptors. An extreme caution is required in the selection of proper dosage, proper analgesic types, and indications for successful pain management. Results and Discussion : With the enactment of "Narcotic control protocol", herbs such as cannibis and poppy are no longer available for use by Korean medicine doctors, and these doctors are faced with difficulty in managing severe pain in the clinical environment. A systematic consideration is inevitable for overcoming the limitation on these analgesics.