SummaryProlongation of the corrected QT (QTc) interval is associated with various anaesthetic drugs. The QTc prolongation may become more exacerbated during laryngoscopy and intubation, which is possibly caused by sympathetic stimulation. The aim of this study was to investigate the effects of fentanyl on the QTc interval during propofol induction in healthy patients. The patients were randomly allocated to receive either fentanyl (n = 25) or saline (n = 25) before induction. The QTc interval was significantly prolonged immediately after intubation in control group compared to preceding values, but it did not change in the fentanyl group. The number of patients with the prolonged QTc interval exceeding 20 ms immediately after intubation compared to the baseline values was 14 in the control group and seven in the fentanyl group. In conclusion, pretreatment with fentanyl 2 μg.kg−1 significantly attenuated QTc prolongation associated with laryngoscopy and tracheal intubation during propofol induction.

Summary Stimulation of the sympathetic nervous system associated with tracheal intubation causes corrected QT (QTc) interval prolongation. We postulated that the use of remifentanil during induction of anaesthesia might prevent this. Sixty unpremedicated, ASA grade 1 patients were selected and randomly allocated to receive either saline (group S), remifentanil 0.5 μg.kg−1 (group R 0.5) or remifentanil 1.0 μg.kg−1 (group R1.0) 1 min before laryngoscopy. The QTc interval was significantly prolonged immediately following intubation in group S and group R0.5, but it remained stable in group R1.0, compared with the QTc interval just before laryngoscopy. It is concluded that the administration of remifentanil 1.0 μg.kg−1 before intubation can prevent the prolongation of the QTc interval associated with tracheal intubation during induction of anaesthesia with sevoflurane.

Pregabalin and gabapentin are lipophilic amino acid derivatives of gamma-amino butyric acid that show anticonvulsant and analgesic activity against neuropathic pain. In this study, we investigated their actions on substance P-induced NF-kappaB activation in human neuroblastoma and rat glioma cells. Pregabalin and gabapentin decreased substance P-induced NF-kappaB activation in these cells. These drugs also inhibited NF-kappaB activation in rat spinal dorsal root ganglia cells pre-treated in vitro with substance P. These results suggest a previously undefined role of pregabalin and gabapentin in the regulation of inflammation-related intracellular signaling in both neuronal and glial cells.

In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA) for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA)-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20–39 years) and elderly (age ≥70 years) patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6–48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, P=0.001). Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%), numbness or motor weakness (67.8% vs 11.5%), urinary retention (7.4% vs 8.7%), dizziness (2.2% vs 5.2%), and hypotension (3.1% vs 20.3%). In conclusion, PCEA was more frequently associated with numbness, motor weakness, and discontinuation of PCA in younger patients and with hypotension, nausea/vomiting, and a greater need for rescue analgesics/antiemetics among elderly patients. Therefore, in order to minimize the adverse effects of PCEA and enhance pain relief, different PCEA regimens and administration/prevention strategies should be considered for young and elderly patients.

Purpose This study aims to estimate PD, T1, T2, T2*, and normalΔB0 simultaneously using magnetic resonance fingerprinting (MRF) with compensation of the linearly varying background field. Methods MRF based on fast imaging with steady‐state precession (FISP) and multi‐echo spoiled gradient (SPGR) schemes are alternatively used, which encode T2 and T2*, respectively. Simulations are performed to determine the appropriate ratio of the FISP and SPGR sections with respect to the T2 and T2* accuracy. Additionally, background field inhomogeneity (Gz) compensation using z‐shim gradients are incorporated into the SPGR section and the dictionary. The background field compensation is tested in the phantom experiment under well‐shimmed and poor‐shimmed conditions. An in vivo experiment is performed and the estimated parameters are compared before and after Gz compensation. Results The T1, T2, and T2* values from the phantom results are in good agreement with the reference methods under well‐shimmed condition. The underestimated T2 and T2* values under poor‐shimmed condition are recovered by Gz compensation and the parameters are also in good agreement with the reference methods. In the human brain, T2 and T2* values are restored by Gz compensation in regions where the magnetic field is particularly inhomogeneous, such as near the sinus and ear canals. Conclusions The proposed FISP and SPGR combined MRF provides a simultaneous estimation of PD, T1, T2, T2*, and normalΔB0. By incorporating field inhomogeneity as a gradient term into both the sequence and dictionary, T2 and T2* values can be restored where field inhomogeneity exists.