Journal of Cellular & Molecular Anesthesia

Cellular and molecular medicine is expanding its clinical role from day to day. Personalized medicine seems the appropraite response for many unresolved problem and this is why we could rely on this approach more than before. Integrating the techniques of cellular and molecular medicine to our daily anesthesia practice improves not only the quality of care; but also, opens new windows for overcoming challenges that were previously considered as unaccessible fields.

Background: As common complications of Coronary artery bypass grafting (CABG), low vascular resistance and hypotension could be life threatening . The aim of present study was to investigate the effect of low-dose vasopressin on hemodynamics in CABG patients.

Material &Methods: In this randomized double-blinded clinical trial, 80 patients undergoing selective CABG were randomly divided into two equal case and control groups (n=40). Case group was received vasopressin 0.03 IU/min 30 minute before the end of cardio-pulmonary bypass (CPB) until one hour after that. Control group was received normal saline in the same manner. Dopamine

 requirement, ICU stay, heart rate (HR), mean arterial blood pressure (MAP), central venues pressure (CVP) and atrial blood acidity (PH) were recorded and compared between groups  in 5 phases ( 0,30,60,90,120 min) after separation of CPB.

Results: There was no significant difference between two groups in number of patients with severe hypotension (11 vs. 12 patients in case and control group respectively). CVP was corrected and then dopamine administration was compared in both group. In vasopressin and placebo group, 3 vs 11 patients need to dopamine administration immediately after separation from CPB (p= 0.018) and 4 vs 12 patients later in ICU (p=0.024) respectively. The mean needed dose of dopamine in vasopressin and placebo group immediately after separation from CPB were 7.63±3.42 vs 9.21±2.08 µg/kg/min (p=0.031) and later in ICU were 7.42±2.02 vs 8.66±4.08 µg/kg/min (p=0.045) respectively, which was significantly lower in vasopressin group in comparison with placebo group.

Conclusion: Based on our results low-dose vasopressin administration significantly reduced the mean needed dose of required dopamine, 24 hours urinary output, Duration of mechanical ventilation and patient’s heart rate.

Abstract

Many patients undergoing surgical procedures experience preoperative anxiety. Therefore; develop a drug as a premedication with strong anxiolytic effect and minimal psychomotor impairment is desirable. Under ethics committee approval, eighty patients, who met the inclusion criteria, were randomly assigned to two groups to receive either oral Valiflore (600 mg, Niak) or placebo as a premedication, 90 minutes before surgery. A numerical rating scale (NRS) for anxiety and the Ramsay sedation scale were measured at baseline, and 15, 30, 60, 90 minutes after premedication. Psychomotor function recovery was assessed using the Digit Symbol Substitution Test and the Trieger Dot Test on arrival in the operating room, 30 and 90 minutes after tracheal extubation. The duration of anesthesia, surgery and recovery time were recorded for each patient. There were no statistically significant differences in the patients’ demographic characteristics, ASA physical status, basal NRS score, the sedation level at different time intervals, duration of anesthesia, surgery and recovery time in the two groups (P > 0.05).The NRS anxiety scores were significantly lower in the Valiflore group in comparison with the control group (P < 0.001). There was no significant difference in psychomotor function test in both groups. Oral Administration of Valiflore as a premedication reduces anxiety before surgery without inducing sedation.

Keywords:

Anxiety; Herbal Medicine; Premedication; Preoperative anxiety; Valiflore

Trial registry number:

IRCT201404115175N13

Short title: Valiflore reduces pre-operative anxiety.

Background: Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago.

Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center.

Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P<0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfusion, compared to those who did not, in both groups. With compared to the past, the patients are older, have less preoperative hematocrit, more diabetic, more need to intra-aortic balloon pump, shorter operation time, and less postoperative bleeding .

Conclusion: With advanced knowledge about transfusion complications and conservative approach to transfusion practice, the need to blood transfusion is increased in current cardiac operations in our center, due to association of more co-morbidities.

The first pediatric lung transplant was performed in 1987 at the University of Toronto in a 15-year-old with familial pulmonary fibrosis. Since that time, over 2000 children have received lung transplants worldwide, with an annual number ranging between 99 and 137 over the past decade. For the anesthesiologist charged with managing these rare patients, an understanding of the indications that lead to transplantation, their pathophysiology, and the physiology of the transplanted lungs are critical. To provide a context for the anesthetic management of the child undergoing lung transplantation, we discuss the case of a 2-month-old who underwent bilateral lung transplantation for intractable respiratory failure. Both the unique aspects of this case and pediatric lung transplantation, in general, are presented. Then a review of the literature is discussed.

Background: Acute perioperative pain is seen in more than 80% of patients undergoing surgery, with almost 75% of them experiencing moderate, severe, or extreme pain; adequate postoperative pain management is not achieved in a satisfactory manner. This styudy was desined ana performed to assess the molecular mechanisms of acute pain management in order to find novel future perspectives.

Materials and Methods: In this narrative review, molecular mechanisms of currently available pain controlling agents were assessed based on 3 steps: preoperative, intraoperative and postoperative phases. Drugs used in each phase and potential novel agents were assessed separately.

Results: many currently available clinical agents were discussed and meanwhile, other potential drugs that could be among the future choices are discussed.

Conclusion: cellular and molecular medicine could open new windows in order to discover novel agents for management of pain; we will have possibly many new agents that will be available in future while they will be different from currently used clinical pain killers.

Congenital factor XIII (FXIII) deficiency is a rare coagulopathy with the highest incidence in Iran. Iranian patients with FXIII deficiency (FXIIID) presented high rate of bleeding episodes, some of them are major cause of disability and mortality among these patients. Hemarthrosis and intracranial hemorrhage (ICH) can affect activity and social productivity of patients. ICH, recurrent miscarriage and umbilical cord bleeding are the major cause of mortality. Hematoma, and prolonged menstrual bleeding as well as post-surgical bleeding are other significant bleeding in Iranian patients with FXIIID. Present of severe life threatening bleeding episodes and other notable bleedings, can significantly reduce working activities and social productivities of patients. Although Iranian patients with FXIIID, experienced significant diseases related complications, early diagnosis accompany by appropriate therapeutic regimes can prevent most of these problems.

Osteogenesis Imperfecta (OI) is a genetic disorder with skeletal, vascular and soft tissue involvement with different clinical presentations. Since these patients need different surgical procedure in their lifetime, anesthesiologists are involved with their perioperative care and should be familiar with pathogenesis and anesthetic considerations of OI. Here we represent a case of OI which was candidate for Video Assisted Thoracic Surgery (VATS) and review the literature.