Journal of Cellular & Molecular Anesthesia

Cellular and molecular medicine is an integrated part of translational medicine, which endeavors to bridge between the traditional classification of "basic and clinical" medicine; aiming clinician-scientists to use their knowledge in designing and developing novel interventions and other specific tools for prevention, diagnosis and treatment of abnormal health conditions.

Abstract

Background: Water retention occurs in most of the congenital heart surgery patients, especially in pediatrics. Ultrafiltration excretes water, electrolytes, many free radicals and inflammatory mediators. The aim of this study was to investigate the effect of modified ultrafiltration (MUF) on the serum levels of TNF-α and IL-6 in pediatrics patients undergoing congenital heart surgeries.Methods and Materials: A total of 91 pediatric congenital heart disease patients candidate for total correction were selected and divided randomly in two groups: CUF (Conventional Ultrafiltration) and CUF+MUF; 40 patients were allocated to CUF group and 51 patients to CUF+MUF group. Serum levels of TNF-α and IL-6 were assessed before CPB and 6 hours after the end of the operation in ICU. Postoperative levels of TNF-α and IL-6 were compared between the two groups.Results: In the MUF+CUF group, the preoperative and postoperative TNF-α levels were 2.5±5.6 and 1.4±3.0 respectively. However, IL-6 serum levels before and after operation were 4.8±8.9 and 41±56. In the CUF only group, the TNF-α level before and after surgery was 3.1±6.2 and 1.0±0.44; respectively; similarly, IL-6 serum levels were 3.3±8.2 and 34.8±37.7.Conclusion: MUF in congenital heart surgery could filtrate excess water and elevate hematocrit but does not have a definitive role in reducing TNF-α and IL-6 serum levels.

Keywords: MUF, TNF-α, IL-6, CUF, cardiopulmonary bypass

Background: The purpose of this randomized, single-center study was to prospectively investigate the impact of anesthetic techniques for craniotomy on the release of cytokines (interleukin (IL)-1, IL-6, tumor necrosis factor factor-alpha (TNF-α)) and to determine whether intravenous anesthesia compared to inhalational anesthesia attenuates the inflammatory response.Methods and Materials: The study enrolled 60 patients undergoing craniotomy, allocated into two equal groups to receive either Isoflurane (n=30) and Propofol (n=30). Non-invasive hemodynamic monitoring was used. Serum levels of IL-1, IL-6 and TNF-α were evaluated before and at the end of surgery and anesthesia.Results: Although there was a significant rise in serum level of inflammatory cytokine but compared with patients anaesthetized with Isoflurane, patients who received Propofol had significant lower levels of IL-1, IL-6 and TNF-a after surgery (p<0.05).Conclusion: Patients who received Propofol had lower levels of IL-1, IL-6 and TNF-α after surgery. Our findings should incite future studies to prove a potential medically important anti-inflammatory role of Propofol in neuroanesthesia.

Background: Communication technology development has provided easier and quicker services in various medical fields. One of the main applications of tele-communication is tele-education, which helps in remote education of students. This study was designed to compare impact of tele-education and regular education methods on anesthesiology residents.Methods and Materials: Anesthesiology residents participated in both tele-education and regular courses during a one-year period. Various related subjects were taught in tele conference and regular sessions. In each course, residents were assessed by pretest and posttest exams. Finally, satisfaction was evaluated regarding quality of sessions using questionnaires especially prepared for the purpose.Results: Mann-Whitney U test showed no statistically significant difference in pretest (p=0.15) and posttest (p=0.07) results of both courses, although this difference was notably in favor of tele- posttest results. The highest rate of satisfaction among residents was dedicated to "saving time" to get to tele conference classes. Moreover, 92.59% of residents preferred to take part in tele conference classes.Conclusion: The study showed that tele-education and regular methods could be equally effective in the education of residents. Some advantages of tele-education for anesthesiology residents were high satisfaction of residents, time saving, and overcoming long distance. Tele-education could be regarded as an effective substitute for regular education of anesthesiology residents.

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Background: Inflammatory pain is caused by direct stimulation of nociceptors with the release of inflammatory mediators. Several studies about the roles of immune and opioid systems in the pain process have suggested that their crosstalk may have effective in pain modulation. Accordingly, the purpose of this study was review the effect of immune and opioid systems on pain modulation.

Evidence acquisition: The increasing demand for mitigating inflammatory pain has led to the introduction of the effect of immune and opioid system interaction in pain modulation. Our literature reviewed 61 articles from 1991 to 2016.

Results: In this study, we reviewed most of the existing papers on the role of opioid system in pain modulation especially with a focus of the immune system efficacy. Our review suggested that there is a close correlation between the expression of cytokines and opioid receptors and in the process of inflammatory pain where immune cells have a notable effect on the expression of cytokines and opioid receptors. In the process of inflammation, different types of immune cells constitute a major source of opioid peptides. The endogenous opioids could modulate either their own secretion or secretion of other cytokines. They have also anti-nociceptive and anti-inflammatory effects.

Conclusion: Exacerbation of immune and opioid system reactions via correlation between cytokines and opioid peptides in the context of inflammatory pain arises the possibility of the role of interaction of these two important systems in the pain process.

 

Keywords: inflammatory pain, opioids, immune system, cytokines, hyperalgesia

 

Introduction: Cardiac arrest during general anesthesia is often witnessed and anticipated with better prognosis. But it may have some difficulties as positions other than supine.

 

Case Presentation: A 43-year-old woman underwent a left radical nephrectomy due to renal cancer while in a lateral position. Her operation was complicated by massive bleeding because of a laceration in the inferior vena cava. Due to rapid blood loss, pulseless electrical activity occurred. Chest compressions were administered with the patient in the lateral decubitus position. Following a blood transfusion, IV fluid administration, FFP, induced hypothermia, fresh whole blood and norepinephrine infusion, the patient was stabilized. She was transferred to ICU, and after 24 hours she was extubated. The next week she was discharged with no neurological damage.

 

Conclusion: Initiating chest compressions as soon as possible even in positions other than supine could minimize hypoxic complications and enhance prognosis of cardiac arrest.