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Printable Handouts
Navigable Slide Index
- Introduction
- Pain: concept and early anatomy
- Enabling technology for spinal anesthesia
- James Leonard Corning (1855-1923)
- Bier and Hildebrand: intrathecal drug delivery
- Rapid evolution of spinal anesthetic delivery in US
- Early appreciation of risks of spinal anesthesia
- Modulation of spinal processing
- Targeting drugs at spinal function
- Other systems which regulate spinal afferent input
- Pain selectively diminished by spinal opioids
- Spinal mu\delta opioid action
- Targeting drugs at spinal function (1)
- Targeting drugs at spinal function (2)
- Targeting drugs at spinal function (3)
- Rat as a surrogate for drugs activity in humans
- Spinal analgesics: animal and human pain
- Safety of spinal drugs
- Safety concerns of spinal drugs
- Early safety issues with spinal anesthetic
- Classes of spinal toxicity
- Intrathecal lidocaine and toxicity
- Spinal toxicity: root
- Spinal toxicity: parenchyma
- Spinal toxicity: meningeal
- Human intrathecal morphine: granuloma
- Morphine and granulomas: concentration vs. dose
- There are no safe drugs, only safe doses
- Safety of spinal drugs: summary (1)
- Safety of spinal drugs: summary (2)
- Future and neuraxial drug delivery
- The canary tale
Topics Covered
- Pain: concepts and early anatomy
- Role of sensory nerves and spinal cord
- Enabling technology for spinal anesthesia
- Rapid evolution of spinal anesthetic delivery in the US
- Early appreciation of risks of spinal anesthesia
- Modulation of spinal processing
- Targeting drugs at spinal function
- Other systems which regulate spinal afferent transmission
- Pain selectively diminished by spinal opioids
- Spinal mu/delta opioid action
- Spinal analgesics: animal and human pain
- Safety of spinal drugs
- Early safety issues with spinal anesthetic
- Classes of spinal toxicity
- Intrathecal lidocaine and toxicity
- Spinal toxicity: root, parenchyma, meningeal
- Human intrathecal morphine: granuloma
- IT morphine and granulomas concentration vs. dose
- Future and neuraxial drug delivery
- Update interview: Neuraxial pain targets
- Update interview: Role of the dorsal root ganglia in pain
- Update interview: Increasing application of spinal neuraxial delivery in managing spinal dysfunction
- Update interview: Mechanisms underlying spinal pathology
- Update interview: Long lasting but reversible therapeutics and which patients benefit
- Update interview: Disease modifying effects
Links
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Talk Citation
Yaksh, T. (2021, February 28). Spinal drug delivery: technology, biology and toxicology [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 3, 2024, from https://doi.org/10.69645/AKRM7945.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Tony Yaksh has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Update Available
The speaker addresses developments since the publication of the original talk. We recommend listening to the associated update as well as the lecture.
- Full lecture Duration: 47:59 min
- Update Interview Duration: 20:29 min
Spinal drug delivery: technology, biology and toxicology
A selection of talks on Neurology
Transcript
Please wait while the transcript is being prepared...
0:00
Hello. I'm Tony Yaksh and I'm vice chair
for the Department of Anesthesiology at the University of California,
San Diego, and I'm Director of the Laboratory of anesthesiology research.
For almost 30 years,
we have had as a primary focus,
research related to the delivery and action of drugs in the spinal cord with
a particular emphasis on issues and pharmacology related to pain nociceptive processing.
Today I would like to give a brief overview of issues pertinent to spinal drug delivery,
particularly as it pertains to a technology, biology, and toxicology.
0:40
The idea of delivering drugs into the spinal cord reflects upon
a fundamental appreciation of the role played by that structure in pain transmission.
The idea that there were pathways leading from the outside to
the brain conceptually certainly goes back to Descarte, if not before.
In this iconic figure of the little boy with his foot proximal to the fire,
the notion was that the information that cause the individual
to have a grimace of his face reflected upon the transfer
of thermal energy to the foot and the activation of information
carrying pathways from the foot to the spinal cord to higher centers,
where the twitching of the pineal gland and the brain was believed to reflect
upon the nature of the pain condition of the stimulus of the outside world.
This notion of a specific pathway carrying information bounds as
its anatomical underpinnings the results from
early studies of 19th Century physiologists and anatomists.
Bell and Magendie, for example,
demonstrated that the dorsal root represented
a primary pathway by which afferent information made its way into the nervous system.
Brown-Sequard and Edinger and other anatomists pointed to the importance of
superficial long tracks in the lateral aspects of the cord for carrying such information.
It felt the Gower in 1888 who,
as a result of clinical observations in clinical case material,
made the prescient observation that pain traveled
as a crossed system in the ventral lateral quadrant of the spinal cord.
One such case, he noted that after ventral lateral tract injury,
that pain was found loss absent on the contralateral side,
whereas light touch was preserved bilaterally.
This observation pointed to the importance of specific pathways at the spinal level of
carrying sensory information relevant to different somatosensory experiences.