Takayasu arteritis is a rare chronic progressive panendarteritis involving the aorta and its main branches. Anesthesia in patients with this disease can be complicated by severe uncontrolled hypertension, end-organ dysfunction, and stenosis of major blood vessels. In this case, general anesthesia was induced with sevoflurane and remifentanil without complications. To prevent intraoperative complications, we conducted intubation with a rigid video laryngoscope with careful consideration of the concentrations of analgesics and sedatives used. This case demonstrates the importance of anesthetic techniques for maintaining adequate tissue perfusion without hemodynamic changes in the anesthetic management of patients with Takayasu arteritis.

Purpose Insulin resistance in patients undergoing invasive surgery impairs glucose and lipid metabolism and increases muscle protein catabolism, which may result in delayed recovery and prolonged hospital stay. We examined whether intra-operative administration of carbohydrates during longduration oral and maxillofacial surgery under general anesthesia affects carbohydrate, proteins, and lipid metabolism and the length of hospital stay.Methods We studied 16 patients with normal liver, kidney, and endocrine functions, and ASA physical status I or II, but without diabetes. Patients were randomly assigned to receive 0.1 g/kg/h of (n=8) or lactatedRinger's solution (n=8). Blood was collected before (T0) and 4 h after (T1) the start of surgery. We analyzed the plasma levels of glucose, ketone bodies, 3-methylhistidine (3-MH), and the length of hospital stay.Results At T0, no statistically significant differences were observed in the levels of glucose, ketone bodies, and 3-MH between the groups. At T1, no statistically significant difference in glucose levels was found between the groups. However, ketone bodies were significantly lower, and the changes in 3-MH levels were significantly less pronounced in the glucose-treated group compared with controls. No significant differences were observed between the groups in terms of length of hospital stay.Conclusions The administration of low doses of glucose during surgery was safe, did not cause hyperglycemia or hypoglycemia, and inhibited lipid metabolism and protein catabolism. Additional experiments with larger cohorts will be necessary to investigate whether intraoperative management with glucose facilitates postoperative recovery of patients with oral cancer.

Purpose: Venipuncture is often accompanied by pain, which can compromise dental care and foment distrust toward dental care providers. The aim of the present study was to identify sites on the forearm and hand that have the greatest pain tolerance threshold (PTT) during venipuncture.Materials and Methods: The PTT was estimated in 20 healthy volunteers using a noninvasive nerve conduction threshold device. The subjects self-stimulated 5 sites (median cubital vein, cephalic vein at the cubitus, basilic vein, cephalic vein at the carpus, and superficial dorsal vein) at 2 kHz, 250 Hz, and 5 Hz. We measured the stimulation intensity before the subject deactivated the device. Differences in the average PTT values at each site were compared using the Kruskal-Wallis and Scheffe tests. P <. 05 was considered to indicate statistical significance.Results: The PTT was significantly greater at the superficial dorsal vein than at the basilic vein for all 3 noninvasive nerve conduction threshold frequencies (P <.05). The estimated PTT was significantly greater at the superficial dorsal vein than at the median cubital vein and cephalic vein at the carpus in response to 250-Hz stimulation (P <.05).Conclusions: The greater PTT of the superficial dorsal vein suggests that venipuncture at this site should result in the lowest pain intensity among all upper limb sites. (c) 2015 American Association of Oral and Maxillofacial Surgeons

PURPOSE: We examined the effects of sweet taste stimulation on pain tolerance threshold (PTT) of oral mucosa in children. SUBJECTS AND METHODS: Subjects comprised 10 children (mean age, 7.3 +/- 1.2 years) for whom PTT of oral mucosa was measured 2 min after oral administrations of sucrose or xylitol and water. Sine wave current stimulation (2 kHz, 250 Hz and 5 Hz, SWCS) which can stimulate sensory nerve fiber selectively (A ss, A delta and C) was used to measure PTT. RESULTS: Sweet taste stimulation with sucrose or xylitol increased oral mucosa PTT in children, but not in adults. No difference in the increased PTT was seen between sucrose and xylitol. CONCLUSIONS: Oral administration of sucrose and xylitol may potentially relieve pain associated with local anesthetic injections in children.

Although recent evidence suggests that central glial hyperactivation is involved in cancer-induced persistent pain, the time course of this hyperactivation and the glial contribution to pain hypersensitivity remain unclear. The present study investigated the time-dependent spatial changes of microglial and astrocytic hyperactivation in the trigeminocervical complex, which consists of the medullary (MDH) and upper cervical (UCDH) dorsal horns, and pain-related behaviors in a rat facial cancer model in which Walker 256B-cells are inoculated into the vibrissal pad. In this model, the tumors grew within the vibrissal pad, from which sensory nerve fibers project into the MDH, but did not expand into the infraorbital region, from which fibers project into the UCDH. Nevertheless, mechanical allodynia and thermal hyperalgesia were observed not only in the vibrissal pad but also in the infraorbital region. Western blotting and immunofluorescence studies indicated that microglia were widely activated in the trigeminocervical complex on day 4 and gradually inactivated by day 11. In contrast, astrocytes were only activated in the MDH on day 4; the hyperactivation later expanded into the UCDH. Daily administration of the glial hyperactivation inhibitor propentofylline beginning on day 4 suppressed the glial hyperactivation on later days. Propentofylline treatment largely prevented allodynia/hyperalgesia in the infraorbital region beginning on day 5, although established allodynia/hyperalgesia in the vibrissal pad was less sensitive to the treatment. These results suggest that central glial hyperactivation, transient microglial hyperactivation and persistent astrocytic hyperactivation, contributes to the development of pain hypersensitivity but not to the maintenance of pain in this model.

European Journal of PainVolume 13, Issue S1 p. S77c-S78 244 THE ANALGESIC EFFECT OF AGMATINE IN FORMALIN-INDUCED PAIN IS ENHANCED BY AN NMDA RECEPTOR ANTAGONIST O. Nakanishi, O. Nakanishi Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorT. Ishikawa, T. Ishikawa Yamaguchi University Graduate School of Medicine, Ube, JapanSearch for more papers by this authorN. Harano, N. Harano Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorS. Shiibs, S. Shiibs Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorK. Ishikawa, K. Ishikawa Yamaguchi University Graduate School of Medicine, Ube, JapanSearch for more papers by this authorM. Nunomaki, M. Nunomaki Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorY. Shizuoka, Y. Shizuoka Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorH. Kawahara, H. Kawahara Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorM. Yoshida, M. Yoshida Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this author O. Nakanishi, O. Nakanishi Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorT. Ishikawa, T. Ishikawa Yamaguchi University Graduate School of Medicine, Ube, JapanSearch for more papers by this authorN. Harano, N. Harano Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorS. Shiibs, S. Shiibs Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorK. Ishikawa, K. Ishikawa Yamaguchi University Graduate School of Medicine, Ube, JapanSearch for more papers by this authorM. Nunomaki, M. Nunomaki Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorY. Shizuoka, Y. Shizuoka Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorH. Kawahara, H. Kawahara Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this authorM. Yoshida, M. Yoshida Kyushu Dental School, Kitakyushu, JapanSearch for more papers by this author First published: 12 January 2012 https://doi.org/10.1016/S1090-3801(09)60247-0Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume13, IssueS1September 2009Pages S77c-S78 RelatedInformation

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