Hasil untuk "Anesthesiology"

Dušica Simić, Duygu Kara, Katarina Stančev et al.

Preoperative preparation is a complex series of steps aimed at establishing the conditions for selecting an individualized perioperative plan, bringing the child to the best possible state of health state, stabilizing higher-risk patients and reducing them to a lower-risk stage, informing parents about the type of anesthesia planned and the potential risks and complications, and minimizing parental anxiety. However, anticipation and the route to surgery create preoperative anxiety in children and their parents. Under conditions of increased stress, the child’s cooperativeness decreases, the requisite dosages of medications for premedication and induction increase, delirium may occur, and wound healing and recovery as a whole are prolonged. Sensitivity to pain also increases, leading to longer hospital stays and less satisfaction among patients and parents. Premedication is tailored to each patient based on age, body weight, health status, psychological profile, and the extent of the intervention. A thorough discussion with the anesthesiologist, a detailed examination, and an individualized anesthetic plan can minimize these effects. This paper describes pharmacological methods of preoperative preparation, provides recommended dosages, and draws attention to the potential side effects of the medications.

Marzieh khalaji, Mohadese Babaie, Fatemeh Bayat et al.

Abstract Aim This study aims at comparing the impact of Magnesium Sulfate and Lidocaine sprays on hemodynamic changes after laryngoscopy and tracheal intubation. Design This double-blind clinical trial (code IRCT20230719058846N1) was conducted on the patients undergoing elective surgery in the city of Karaj. Methods A total of 100 patients, aged 18 to 40 years and classified as ASA I or II, who were candidates for elective surgery, were randomly assigned to two equal groups. Prior to intubation, patients received lidocaine spray (5 puffs of Lidocaine 10%) in one group, and magnesium sulfate spray (5 puffs of Magnesium 20%) in the other. Induction of anesthesia was the same in both groups. Patients’ hemodynamic statuses were measured and compared once before the intubation and also 1, 3, 5, 7 and 10 min after it. Results Before the intervention, there was no statistically significant difference between the two groups in terms of demographic and hemodynamic variables (P < 0.05). The results showed that the systolic blood pressure at minutes 3, 5, and 7 was significantly lower among the patients receiving magnesium than those receiving lidocaine (P < 0.05). Other hemodynamic variables were not statistically different between the two groups (P < 0.05). Conclusion Based on the findings of the present study, magnesium sulfate spray is more effective than lidocaine in controlling hemodynamic complications. Therefore, it can be used to reduce hemodynamic complications following intubation. However, it may be associated with tachycardia, which needs to be taken into account.

Dong Wang, Ying Chen, Changping Gu et al.

Amit Goel

Qingfeng Fan, Mohamad Hadla, Zack Peterson et al.

Key Points. PIEZO1 activation reduces cystogenesis: Yoda1 activates PIEZO1, raising calcium and lowering cAMP, reducing cyst growth in autosomal dominant polycystic kidney disease models. Context-dependent role of PIEZO1: PIEZO1 knockout in mice with or without polycystic kidneys does not affect cyst formation, suggesting redundancy in mechanosensitive pathways. Therapeutic potential: Findings support PIEZO1 activation as a part of combination therapy to slow cyst growth in autosomal dominant polycystic kidney disease, needing more in vivo studies. Background. The disruption of calcium signaling associated with polycystin deficiency is a key factor in abnormal epithelial growth in autosomal dominant polycystic kidney disease. Calcium homeostasis can be influenced by mechanotransduction. The mechanosensitive cation channel PIEZO1 has been implicated in sensing intrarenal pressure and regulating urinary osmoregulation, but its role in kidney cystogenesis is unclear. Methods. We hypothesized that altered mechanotransduction contributes to cystogenesis in autosomal dominant polycystic kidney disease and that activation of mechanosensitive cation channels could be a therapeutic strategy. Results. We demonstrate that Yoda1, a PIEZO1 activator, increases intracellular calcium and reduces forskolin-induced cAMP levels in mouse inner medullary collecting duct (mIMCD3) cells. Notably, knockout of polycystin-2 attenuated the efficacy of Yoda1 in reducing cAMP levels in mIMCD3 cells. Yoda1 also reduced forskolin-induced mIMCD3 cyst surface area in vitro and cystic index in mouse metanephros ex vivo in a dose-dependent manner. However, collecting duct–specific PIEZO1 knockout neither induced cystogenesis in wild-type mice nor altered cystogenesis in the Pkd1RC/RC mouse model. Conclusions. These findings support the potential role of PIEZO1 agonists in mitigating cystogenesis by increasing intracellular calcium and reducing cAMP levels, but the unaltered in vivo cystic phenotype after PIEZO1 knockout in the collecting duct suggests possible redundancy in mechanotransductive pathways.

Lingli Qin, Ping Song, Xian Li et al.

Abstract Introduction Tension-type headache (TTH) is common but challenging to manage due to limited effectiveness of conventional treatments. This study examines six complementary and alternative medicine (CAM) interventions through network meta-analysis to identify effective TTH management strategies. Methods We searched PubMed, Embase, Web of Science, Cochrane Library, OVID, CNKI, Wanfang, VIP, and CBM databases for randomized controlled trials on CAM for TTH treatment. Headache frequency and intensity were the primary outcomes. Methodological quality was evaluated on the basis of the Cochrane risk of bias tool. We used R software to conduct this Bayesian network meta-analysis. We used mean difference (MD) with 95% credible intervals (CI) to calculate the continuous outcomes and analyzed the percentages of the surface under the cumulative ranking (SUCRA) curve. Results In total, 32 randomized controlled trials (RCTs) with 2405 participants were analyzed. For reducing headache intensity, the network meta-analysis shows that acupuncture therapy combined with traditional Chinese medicine (AT_TCM), manual therapy (MT), psychological treatment (PT), and traditional Chinese medicine combined with acupuncture and manual therapy (TCM_AT_MT) are superior to Western medicine (WM). In the SUCRA curve, TCM_AT_MT is the best for reducing headache frequency (HF). Conclusions This review, assessed as low-quality evidence by GRADE, cautiously suggests potential benefits of PT over other CAM interventions for TTH and indicates TCM_AT_MT might better reduce HF. It proposes that combining CAM interventions could enhance outcomes. Due to the preliminary nature of these findings, further high-quality RCTs are essential to confirm these suggestions and provide clearer clinical guidance. PROSPERO Registration Number CRD42021252073.

E. D. Van Der Zwaag, N. A. Bohannon, S. L. Thompson et al.

Kleefstra syndrome (KS) is a genetic disorder caused by a microdeletion in the 9q34.3 chromosome with related clinical conditions requiring surgical intervention and careful consideration for anesthetic management includ- ing potential difficult airway, cardiac and neurological considerations, pulmonary infections, reflux and delayed gastric emptying, genitourinary abnormalities, hypoto- nia, and seizure disorders. In addition, we observed unique perioperative pain control considerations. We pre- sent a clinical case involving a 2-year-old female who re- ceived anesthesia for robotic ureteral reimplantation sur- gery. Perioperative implications are discussed and con- siderations for anesthetic care provided.

Zhuo Liu, Dongxin Wang, Qian Cao et al.

Colorectal cancer (CRC) is a worldwide disease posing serious threats to people’s life. Surgery and postsurgical chemotherapy are still the first choices to control the rapid progression of cancer. However, tumor recurrence and even distant metastasis are prone to occur. As a result, it is in urgent demand to find a new method to control CRC progression while inhibiting distant metastasis. On this basis, this study developed the three-layered functionalized hydrogel-fibrous membrane-hydrogel composite materials. The Chinese traditional drugs 20 (S)-ginsenoside Rg3 (Rg3) and chemotherapeutic agent 5-fluorouracil (5-Fu) were loaded in the inner hydrogel and middle fibrous membrane and could be constantly released at the same time and space. The outer hydrogel was decorated with phenylboronic acid (PA) to interact with sialic acid expressed on the CRC cell surface. The composite materials possessed biocompatibility and showed no toxicity to normal human intestinal mucosa endothelial cells HIEC. According to the results, the cell viability of CT26 could be significantly decreased in vitro. The three-layered functionalized materials inhibited the original tumor progression and distant tumor metastasis to the liver in an orthotopic colon cancer mouse model by increasing the caspase3 expression and inhibiting the expressions of Bcl-2, Ki-67, and VEGF. In addition, the functions of major organs were not significantly damaged. Our study provides a safe and efficacious method of this three-layered functionalized hydrogel-fibrous membrane-hydrogel composite materials for CRC treatment.

Alaa Ali M. Elzohry, Osama G Alghamdi, Mohammed L Helmy et al.

Postoperative myoclonic movement (PMM) is an uncommon side effect after general anesthesia (GA), and the exact cause of this neurologic complication is still unknown. Many factors such as anesthesia, psychological stresses, and surgical stress could trigger PMM. We are here reporting a case of PMM in the post-anesthetic care unit (PACU) following general anesthesia in an apparently healthy patient.

Arshed H Parry, Haseeb A Wani, Mudasira Yaseen

Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is a highly contagious infectious disease and spreads through aerosols and fomites. Health care personnel who are at the forefront of the fight against coronavirus disease-19 (COVID-19) pandemic are also at greater risk of contracting the infection. Mixing of uninfected people with infected people is potentially hazardous, especially in a radiology department. Implementation of meticulous operational changes, curtailment of nonurgent radiological work, rationalization of staff, equipment disinfection, use of personal protection equipment, and psychological support are needed to combat COVID-19 or any such infectious disease outbreak. This technical note will familiarize radiology workers with infectious disease outbreak-response to be adopted to ensure the safety of staff and patients.

Garaniya Roopal R., Mehta Pancham, Shiyal Kishan et al.

Introduction: Patient satisfaction is an integral part of the quality of healthcare processes. The survey performed by the ASA Committee on Performance and Outcomes Measurement (CPOM) in 2013 states that the assessment of patient satisfaction is a reality of practice today. Thus, this study aimed to assess patient satisfaction with perioperative anaesthesia services and determine the factors influencing patient satisfaction in our hospital. Methods: We performed the cross-sectional study at our tertiary care institute after getting institutional review board approval. This study included 200 patients who underwent elective or emergency surgeries under anesthesia from April 2019 to June 2019. The long-form questionnaire was prepared based on various references and validated in our department. Results: Out of 200 patients, 76.5% (n = 153) were satisfied with anaesthesia services. Male gender [87.03% (n = 94/108)], younger [86.66% (78/90)] and literate patients [ 88.52% (108 pts/122)] were more satisfied. Better satisfaction was recorded in patients who had regional anaesthesia [85.18% (92/108)] and no complain of post-operative pain [83.58% (112/134)] or postoperative nausea and vomiting (PONV) [87.90% (109/124)]. Patients with intraoperative awareness were less satisfied. Conclusion: In our study group, type of anaesthesia, postoperative pain, PONV, and intraoperative awareness were factors that affected patient satisfaction.

Chung-Hau Juan, Mei-Hsiu Chen, Feng-Hui Lin et al.

Human placenta-derived multipotent stem cells (PDMCs) resembling embryonic stem cells can differentiate into three germ layer cells, including ectodermal lineage cells, such as neurons, astrocytes, and oligodendrocytes. The favorable characteristics of noninvasive cell harvesting include fewer ethical, religious, and legal considerations as well as accessible and limitless supply. Thus, PDMCs are attractive for cell-based therapy. The Schwann cell (SC) is the most common cell type used for tissue engineering such as nerve regeneration. However, the differentiation potential of human PDMCs into SCs has not been demonstrated until now. In this study, we evaluated the potential of PDMCs to differentiate into SC-like cells in a differentiation medium. After induction, PDMCs not only exhibited typical SC spindle-shaped morphology but also expressed SC markers, including S100, GFAP, p75, MBP, and Sox 10, as revealed by immunocytochemistry. Moreover, a reverse transcription-quantitative polymerase chain reaction analysis revealed the elevated gene expression of S100, GFAP, p75, MBP, Sox-10, and Krox-20 after SC induction. A neuroblastoma cell line, SH-SY5Y, was cultured in the conditioned medium (CM) collected from PDMC-differentiated SCs. The growth rate of the SH-SY5Y increased in the CM, indicating the function of PDMC-induced SCs. In conclusion, human PDMCs can be differentiated into SC-like cells and thus are an attractive alternative to SCs for cell-based therapy in the future.

Emine Çepni Kütahya, Bahar Oc, Ceyhan Ugurluoglu et al.

Objective: The aim of this animal study was to investigate the short and long-term local histomorphologic effects and the utility of intra-articular application of ibuprofen. Methods: Forty-six Wistar Albino rats were used in the study. The rats were randomized into 5 groups of 8 and a sham group of 6. The 40 rats in the study groups were anaesthetised with 60 mg/kg of ketamine, then 0.25 ml ibuprofen (25 mg) was injected to the right knee joint of each rat (ibuprofen group) and 0.25 ml 0.9% saline to the left knee joint as the control group. To the 6 rats in the sham group, only puncture was applied to both knee joints. The rats in each of the 5 study groups were sacrificed on days 1, 2, 7, 14 and 21 respectively. The histomorphologic changes were graded on a 6-point scale regarding inflammation of the synovia, cartilage tissue, and subchondral bone. Inflammation scores were compared using the Mann Whitney U-test and comparisons of the sacrifice day and drug used were evaluated with the Kruskal Wallis test. The p values below 0.05 were considered as significant. Results: Statistically significant difference was found between the ibuprofen injected knees (10/40) and the saline injected (0/40) and sham knees (0/12) in respect of hematoma positivity (p = 0.002). Significantly higher inflammation scores were found in ibuprofen injected knees on the 1st, 2nd, 7th and 14th days compared to controls and sham (p < 0.05). Inflammation scores were similar in ibuprofen injected knees with and without hematoma (p > 0.05). Inflammation of the ibuprofen injected group was most severe on day one and the severity of inflammation reduced gradually throughout the 3 weeks. Conclusion: Our results show that intra-articular injection of ibuprofen can cause intra-articular hematoma. It also leads to transient inflammation of the synovia that is more severe in the early period, which gradually recovers. Keywords: Ibuprofen, Intra-articular, Knee, Synovium, Cartilage

Ji Peng, Peng Zhang, Han Zheng et al.

Purpose: To investigate whether dexmedetomidine (Dex) can reduce the production of inflammatory factor IL-1β by inhibiting the activation of NLRP3 inflammasome in hippocampal microglia, thereby alleviating the inflammatory response of the central nervous system induced by surgical injury. Methods: Exploratory laparotomy was used in experimental models in this study. Totally 48 Sprague Dawley male rats were randomly divided into 4 groups (n = 12 for each), respectively sham control (group A), laparotomy only (group B); and Dex treatment with different doses of 5 μg/kg (group D1) or 10 μg/kg (group D2). Rats in groups D1 and D2 were intraperitoneally injected with corresponding doses of Dex every 6 h. The rats were sacrificed 12 h after operation; the hippocampus tissues were isolated, and frozen sections were made. The microglia activation was estimated by immunohistochemistry. The protein expression of NLRP3, caspase-1, ASC and IL-1β were detected by immunoblotting. All data were presented as mean ± standard deviation, and independent sample t test was used to analyze the statistical difference between groups. Results: The activated microglia in the hippocampus of the rats significantly increased after laparotomy (group B vs. sham control, p < 0.01). After Dex treatment, the number was decreased in a dose-dependent way (group D1 vs. D2, p < 0.05), however the activated microglia in both groups were still higher than that of sham controls (both p < 0.05). Further Western blot analysis showed that the protein expression levels of NLRP3, caspase-1, ASC and downstream cytokine IL-1β in the hippocampus from the laparotomy group were significantly higher than those of the sham control group (all p < 0.01). The elevated expression of these proteins was relieved after Dex treatment, also in a dose-dependent way (D2 vs. D1 group, p < 0.05). Conclusion: Dex can inhibit the activation of microglia and NLRP3 inflammasome in the hippocampus of rats after operation, and the synthesis and secretion of IL-1β are also reduced in a dose-dependent manner by using Dex. Hence, Dex can alleviate inflammation activation on the central nervous system induced by surgical injury. Keywords: Dexmedetomidine, Hippocampal microglia, Inflammasome, IL-1β

Jovičić Jelena, Volaš Ljubiša, Brkić Tatjana et al.

Introduction: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. The central neuropathic pain includes thalamic pain syndrome, pain related to multiple sclerosis, poststroke pain, post spinal cord injury pain. Almost 60% of patients with spinal cord injuries have neuropathic pain whose treatment requires great socioeconomic support for a long time. Case Report: Male, 56 years old, previously healthy, was examined at the Outpatient pain Clinic, Clinical Centre of Serbia. He complained about a strong pain in both legs and a sense of tightening around the trunk. The pain was present on rest and getting worse on mobilization, intensity 7-10/10 by NRS. In 2008. after falling into the shallow water, he sustained comminuted C7 fracture resulting in quadriplegia. He was operated and regained motor skills in both arms with some residual sensory deficits. Detailed neurological examination diagnosed the presence of neuropathic pain in the trunk (T4-L1 dermatome being the worst pain with hyperalgesia, dysesthesia, hyperpathia), with sensitivity fairly preserved. Regarding therapy, only fentanyl patches helped with the dose increase but tightening sense persisted. Combined lidocaine and ketamine infusion was applied - the response was temporarily good. The patient still feels pain and uses fentanyl patches, baclofen and physical therapy. Discussion: Treatment of neuropathic pain represents a great socioeconomic problem even for developed countries because there is no benefit of conventional pharmacologic therapy in long-term use. Also, neuromodulatory therapy methods provide the most benefits for this group of patients but demand trained personnel and use of expensive equipment. Conclusion: This case is a good example of difficulties regarding treatment of this type of chronic pain in a developing country: limits of pharmacotherapy, no trained doctors for implantation of neuromodulatory devices, high price of neuromodulatory devices.

Erdinc Soylu, Emaddin Kidher, Hutan Ashrafian et al.

Abstract Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique. There were no mortalities (0%; 0/47). In 12 studies, the follow-up period was longer than 30 days. There were no post-operative complications apart from one case of atrial fibrillation (2.2%; 1/46). Complete resection of left ventricular lesion was achieved in all cases (100%; 50/50). These successful results demonstrate that the cardio-endoscopic technique is a useful adjunct in resection of left ventricular tumours, thrombus and hypertrophic myocardium. This approach facilitates accurate resection of pathological tissue from left ventricle whilst avoiding exposure related valvular damage and adverse effects associated with ventriculotomy. Future research should focus on designing adequately powered comparative randomised trials focusing on major cardiac and cerebrovascular morbidity outcomes in both the short and long-term. In this way, we may have a more comprehensive picture of both the safety and efficacy of this technique and determine whether such devices could be safely adopted for routine use in minimal access or robotic intra-cardiac surgery.

Anand Bangera

Adenotonsillectomy remains one of the most common surgical procedures carried out in children. Though a commonly performed procedure, it poses a great challenge to the surgeon as well as the anaesthesiologist and is associated with a substantially increased risk of morbidity and mortality. In the post-operative period, it poses threats such as post-tonsillectomy bleeding and airway obstruction if not diagnosed and treated promptly. Various recent advances in airway management and early detection of post-operative complications have been made to reduce the sequelae associated with tonsillectomy. In this article, we have reviewed the various techniques, complications and recent advances, which have evolved in the anaesthetic technique related to adenotonsillectomy.

Hyung Joon Kim, Yun Hee Lim, Byung Hoon Yoo et al.

To avoid the occurrence of fatal complications of blood transfusion, several tests are implemented before transfusion. The tests include ABO typing, Rh typing, cross-matching test and blood antibody screening test, and in usual they are completed before transfusion. However in the case of repetitive operations done via brief distance, reexamination for blood antibody tends to be omitted. After 2 previous operations, 30 years old male patient showed positive blood antibody screening during the third operation. Although antibody screening test performed before the first operation, no unexpected blood antibody was detected. During the third operation, after the decision to start transfusion was made, it took two hours to find appropriate blood. There was no significant deterioration of patient's condition but the loss of time could lead to critical consequences. We present this case to make anesthesiologists and surgeons aware of possibility of unexpected blood antibody detection after transfusion.

Idoris Cordero Escobar

Gayatri Sakrikar, Chinmaya P. Bhave, Rajashree U. Gandhe