- Email: [email protected]
160: Videothoracoscopic sympatectomy in the tratment of refractory angina pectoris
58
Posters
•
Chronic Pain Management
159. The effectiveness of intravenous ketamine and magnesium in patients with postherpetic neuralgia
160. Videothoracoscopic sympatectomy in the tratment of refractory angina pectoris
Y.H. Kim1, Y.O. Park1, Y.C. Kim2, P.B. Lee1 of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam-si, South Korea, 2Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
M. Stritesky1, R. Demes2, M. Dobias1, D. Rubes1 1Dept. of Anaesthesia and Intensive Care, Prague Faculty Hospital, Prague, Czech Republic, 2Dept. of General Surgery, Prague Faculty Hospital, Prague, Czech Republic
1Department
Background: Postherpetic neuralgia (PHN) is the most frequent debilitating complication and one of the most intractable pain disorders, particularly among elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapy. We assessed the analgesic effect of ketamine and magnesium for PHN via an open prospective study. Method: Forty-five patients with severe, intractable PHN and unresponsive to conservative therapy were involved. The effects of ketamine hydrochloride (Ketara®, Parke Davis) 1 mg/kg and magnesium sulfate (Magnesin®) 30 mg/kg were investigated. Saline was used as placebo. Pain ratings were conducted on a visual analogue scale (VAS) at 1, 2, and 4-week follow-up. Results: Demographic and non-interventional clinical factors, including age, sex, duration of symptoms revealed no significant effect on patient outcome at 4-week follow-up. Response to treatment, defined as 50% reduction in VAS-score after infusion, was recorded in 10/15 in the ketamine, 7/15 in the magnesium and 2/15 in the placebo. The difference in VAS reduction was significant between the ketamine and the placebo group and between the magnesium and the placebo. Conclusions: Ketamine and magnesium showed a significant analgesic effect in patients with postherpetic neuralgia.
Background and Aims: Refractory angina pectoris is defined as severe disabling angina in spite of optimal medical therapy and where percutaneus coronary intervention (PCI) or coronary artery bypass surgery (CABG) is not feasible. According to new evidence in the pathophysiology of an ischaemic myocardium and an impact of thoracic sympathectomy on this myocardium videoscopic thoracic sympathectomy (VTSY) seems to be one of the possible alternative methods in the treatment of refractory angina pectoris. The aim of the study was to document an improvement in the quality of life in a group of patients with refractory angina during the early postoperative period and a one year follow-up. Methods: Between the years 1998-2005 15 patients (pts) aged 52-84 (mean 64) years with angina pectoris class IV according to CCS classification refractory to a conventional therapy underwent videothoracoscopic sympathectomy. VTSY was performed under general anaesthesia with selective single lung ventilation. Bilateral gangliectomy at the levels Th2-Th5 was performed in 12 patients, in 3 patients only unilateral, transection of intergangliac connections was achieved in two patients because of anatomical conditions. To verify the effect of sympathectomy we have introduced a method of myocardial scintigraphy using metaiodinebenzylguanid (I-123 MIBG). Ambulatory control was performed 12-months after the VTSY. Results: Average hospital stay was 4.9 days (4-10 days), no mortality or serious complications were observed. 12 months results: Pain decreased on the average from level 10 to 4,1 according to the visual analogy scale (interval 2-10). The preoperative angina class dropped from class IV to a postoperative average of 2.2 (interval 2-4). MIBG shows a decrease in the index H/M. Conclusion: VTSY was performed in 15 patients with refractory angina pectoris with very good early and 12-months follow-up results. VTSY was associated with reduction in angina symptoms, an improved quality of life was evident.
Posters
•
Chronic Pain Management
159. The effectiveness of intravenous ketamine and magnesium in patients with postherpetic neuralgia
160. Videothoracoscopic sympatectomy in the tratment of refractory angina pectoris
Y.H. Kim1, Y.O. Park1, Y.C. Kim2, P.B. Lee1 of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam-si, South Korea, 2Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
M. Stritesky1, R. Demes2, M. Dobias1, D. Rubes1 1Dept. of Anaesthesia and Intensive Care, Prague Faculty Hospital, Prague, Czech Republic, 2Dept. of General Surgery, Prague Faculty Hospital, Prague, Czech Republic
1Department
Background: Postherpetic neuralgia (PHN) is the most frequent debilitating complication and one of the most intractable pain disorders, particularly among elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapy. We assessed the analgesic effect of ketamine and magnesium for PHN via an open prospective study. Method: Forty-five patients with severe, intractable PHN and unresponsive to conservative therapy were involved. The effects of ketamine hydrochloride (Ketara®, Parke Davis) 1 mg/kg and magnesium sulfate (Magnesin®) 30 mg/kg were investigated. Saline was used as placebo. Pain ratings were conducted on a visual analogue scale (VAS) at 1, 2, and 4-week follow-up. Results: Demographic and non-interventional clinical factors, including age, sex, duration of symptoms revealed no significant effect on patient outcome at 4-week follow-up. Response to treatment, defined as 50% reduction in VAS-score after infusion, was recorded in 10/15 in the ketamine, 7/15 in the magnesium and 2/15 in the placebo. The difference in VAS reduction was significant between the ketamine and the placebo group and between the magnesium and the placebo. Conclusions: Ketamine and magnesium showed a significant analgesic effect in patients with postherpetic neuralgia.
Background and Aims: Refractory angina pectoris is defined as severe disabling angina in spite of optimal medical therapy and where percutaneus coronary intervention (PCI) or coronary artery bypass surgery (CABG) is not feasible. According to new evidence in the pathophysiology of an ischaemic myocardium and an impact of thoracic sympathectomy on this myocardium videoscopic thoracic sympathectomy (VTSY) seems to be one of the possible alternative methods in the treatment of refractory angina pectoris. The aim of the study was to document an improvement in the quality of life in a group of patients with refractory angina during the early postoperative period and a one year follow-up. Methods: Between the years 1998-2005 15 patients (pts) aged 52-84 (mean 64) years with angina pectoris class IV according to CCS classification refractory to a conventional therapy underwent videothoracoscopic sympathectomy. VTSY was performed under general anaesthesia with selective single lung ventilation. Bilateral gangliectomy at the levels Th2-Th5 was performed in 12 patients, in 3 patients only unilateral, transection of intergangliac connections was achieved in two patients because of anatomical conditions. To verify the effect of sympathectomy we have introduced a method of myocardial scintigraphy using metaiodinebenzylguanid (I-123 MIBG). Ambulatory control was performed 12-months after the VTSY. Results: Average hospital stay was 4.9 days (4-10 days), no mortality or serious complications were observed. 12 months results: Pain decreased on the average from level 10 to 4,1 according to the visual analogy scale (interval 2-10). The preoperative angina class dropped from class IV to a postoperative average of 2.2 (interval 2-4). MIBG shows a decrease in the index H/M. Conclusion: VTSY was performed in 15 patients with refractory angina pectoris with very good early and 12-months follow-up results. VTSY was associated with reduction in angina symptoms, an improved quality of life was evident.