Journal of Cellular and Molecular Anesthesia
Year:2018 | Volume:3 | Issue:2|Papers Count:7

Since 1986 that Dr Charles E. Murry and his colleagues published their discovery about the protective effects of ischemic preconditioning (IPC), a large number of Pro-and Con-studies have been published (1). Besides the protective effects of ischemia itself, a number of pharmaceutical agents may have protective effects against ischemia known as pharmacologic preconditioning. Having a long list of agents, these have been under examinations both clinically and/or in lab setting. Some disease states have been proposed to have a relationship with effects of IPC; including diabetes or high altitude diseases (2, 3). Another variety of IPC is remote IPC which has been acting at remote organ tissues (4-6)....

Background: Coronary artery bypass grafting (CABG) is among the most common cardiac surgery procedures carried out on heart pump. However, there are always risks for potential neurologic and neurocognitive insults in CABG. One of the biomarker of central nervous system (CNS) is s100β that shows damage. Cerebral oximetry using near-infrared spectroscopy (NIRS) developed for CNS monitoring especially in cardiac surgery. This study was designed to find the relationship between serum levels of s100β and cerebral oximetry in CABG patients. Materials and Methods: In an observational study, 44 adult patients (40-75 years) entered the study for elective CABG. Serum levels of s100β were assessed at two times during cardiopulmonary bypass (CPB); i. e. just after aortic clamping and immediately after aortic declamping; while the results were compared with right and left cerebral oximetry readings NIRS. It was measured at baseline, during start of cardiopulmonary bypass (CPB), during aortic clamping, and finally at off-clamping the aorta. Repeated Measures ANCOVA (analysis of covariance), multiple linear regression models and Spearman correlation coefficient with scatter plot were used for data analysis. P value less than 0. 05 considered significant. Results: There was no linear correlation between s100β and NIRS according to correlation coefficients. The only positive linear relationship between s100β and right NIRS was observed among patients whose s100β was more than 10 (spearman correlation coefficient= 0. 792; P value=0. 006). Conclusion: This study failed to demonstrate a relationship between on-CPB NIRS numbers and serum s100β in adult patients undergoing CABG during the bypass interval; further studies are suggested to evaluate potential predictive value of NIRS in brain ischemia related to CABG.

Background: Selenium presents anti-inflammatory and antioxidant properties which plays a critical role in nutrition of patients following devastating conditions. Furthermore, several lines of evidence reported that most of patients who admitted to intensive care unit (ICU) have lower plasma levels of selenium. Therefore, this study was designed to define the impact of selenium supplementation on clinical outcomes of mechanically ventilated non-surgical/traumatic critically ill patients. Materials and Methods: This study was conducted on 105 subjects hospitalized in ICU of Shohadaye Haft-e Tir Hospital, Tehran, Iran. Here the acute physiologic assessment and chronic health evaluation (APACHE) II score of patients was documented on the day of their ICU admission. The patients were divided to two groups based on block randomization technique and were assigned to receive selenium or placebo. Then the effect of selenium supplementation was evaluated based on the APACHE II score, the occurrence of ventilator associated pneumonia (VAP), length of ICU stay and the rate of mortality. Results: The acquired data revealed no significant difference between two experimental groups based on the demographical information. Also it was demonstrated that selenium supplementation of critically ill patients was associated with better APACHE II score, fewer length of ICU stay and fewer mortality rate. Incidence of VAP indicated no significant difference between groups. Conclusion: The obtained data of this single center clinical trial showed that selenium supplementation could improve clinical outcomes of critically ill patients.

Background: There is no consensus regarding the spread of local anesthesia in thoracic epidural space to obtain regional analgesia or anesthesia. We aimed to determine the distribution of Bupivacaine injected into the thoracic epidural space to evaluate its cranial or caudal spread in patients undergoing epidural anesthesia. Materials and Methods: In a prospective clinical trial, thirty adults patients (12 males and 18 females) with ASA class I and II, scheduled for elective cholecystectomy under thoracic epidural anesthesia with 0. 5% Isobaric Bupivacaine were studied. Clinical and radiological outcomes were evaluated to assess the correlation between the volume of the local anesthetic injected to the thoracic epidural space and the extension of its spread within the epidural space. Immediately after insertion and fixation of epidural catheter, patients were transferred to MRI unit to receive 8 mL of 5% Bupivacaine plus 1 mL Magnevist through the epidural catheter. Then, the patterns of spread were evaluated. Data were obtained prospectively during the procedure. Results: Mean distribution of bupivacaine in thoracic epidural space was 0. 64 level/ml of local anesthetics and the average of spread was 5. 21 levels. The mean spread of bupivacaine was more in females (5. 5 ± 1. 1) than males (4. 8 ± 1. 1); but the difference was not significant. Unlike Patients’ age and weight, the height and body mass index had a significant negative correlation with the distribution of Bupivacaine. Conclusion: Distribution of Bupivacaine in epidural space in female patients is more than male ones and the tendency of spread is more toward the cephalad direction than caudal.

Background: One of the most important issues in the field of surgery is ischemic preconditioning (IPC) of the myocardium during the coronary artery bypass grafting (CABG). The current study attempted to reevaluate the issue to find a potential approach to diminish morbidity, inotrope administration, ischemia and possibly intensive care unit stay after CABG in adult patients. Materials and Methods: Through randomized single-blind clinical trial, all elective coronary bypass surgeries in 40 to 80 years-old patients enrolled the study. Atrioventricular (AV) block (mobitz2); complete heart block; left bundle branch block (LBBB); acute heart failure (ejection fraction (EF) <30%); re-exploration due to surgical complications and MI cases in the last 7 days were excluded. In all patients, induction (sufentanil, cis-atracurium and etomidate) and maintenance phase (sufentanil, midazolam, cis-atracurium) of anesthesia were done following the same protocol. After cross-clamp of aorta in intervention group, the patients received oxygen (2Lit/min) and sevoflurane (4%) during coronary bypass surgery. After rewarming of the patients, sevoflurane was discontinued. Main outcome measures were troponin 4, 8, 24, 48 hours after surgery with charting the electrocardiogram (ECG) changes, need for inotrope agents and hemodynamic indices during and after CABG in ICU. Results: 58 CABG candidates enrolled the current study: 29 in intervention group and 29 in control group. There were no statistical differences between the groups concerning hemodynamic issues, Central Venous Pressure (CVP), hematocrit (HCT), ECG changes, demands for inotrope, or ICU stay between the groups. Conclusion: No significant relationship between application of 4% sevoflurane and IPC was found in adult CABG patients. However, the effect of Sevoflurane on IPC might be dose-related.

Background: Adequate pain control is a goal in postoperative recovery. Although opioids provide good analgesic effects, their side effects such as postoperative nausea and vomiting (PONV) limit their administration. Intravenous Paracetamol as a safe and well-tolerated drug with fewer side effects can be used instead of opioids for pain management. The aim of this study is to compare preemptive or preventive administration of paracetamol with placebo group to investigate its effects on pain control and opioid consumption in patients undergoing laparoscopic nephrectomy. Materials and Methods: Ninety patients were randomly divided to three groups. Preemptive group received 1 gram Paracetamol in 100 milliliters of 0. 9% saline 30 minutes before induction of anesthesia, the preventive group received 1 gram paracetamol in 100 milliliters of 0. 9% saline before closure of the skin and placebo group just received 100 milliliters of 0. 9% saline. Post-surgical pain was assessed using verbal rating scale (VRS). Pethidine 0. 25 mg/kg was administered and repeated each 10 minutes to control pain as needed. Pain scores, total dose of opioid and symptoms like nausea and vomiting were recorded. Results: Preemptive and preventive groups had lower pain scores than placebo group. Opioid consumption and PONV were significantly higher in placebo group. No significant differences were observed between Preemptive and preventive groups. Conclusion: Intervenes Paracetamol can provide an adequate pain control with few side effects and may be an effective choice in management of postoperative pain in patients undergoing laparoscopic nephrectomy.

Blood transfusions cause to increase oxygen-carrying capacity and intravascular volume. Despite all the benefits of transfusion, it may have some complications. When mistransfusion occurs or when no other option is available, incompatible packed-cells may be infused, which puts the patient at risk of experiencing a hemolytic transfusion reaction (HTR). The HTRs are classified as acute or delayed reactions have wide spectrum of clinical presentations. In this report, we present a case of delayed hemolytic reaction due to rhesus factor (Rh) incompatibility in the operation room. Critical incident reporting and evaluation of adverse transfusion reactions may provide data for effective patient management and prevent the occurrence or repetition of these events.