During the last two decades, there was a growing approach towards role of perioperative medicine as "the future of anesthesia". Many practical and discipline activities were performed; including change in clinical practice and change in the name of departments to "Department of Anesthesia and Perioperative Medicine" or similar titles. These changes were based on a distinct logic: Anesthesia is not a spot or a brisk interval of care. Instead, it starts from "preoperative anesthesia care", goes to "intraopera tive anesthesia care" and leads to postoperative anesthesia care". This approach adapts more with improved clinical outcome

Original Articles

Does increased Nitric Oxide production and oxidative stress due to high fat diet affect cardiac function after myocardial infarction?

Marjan Aghajani, Alireza Imani, Mahdieh Faghihi, Mohammad Reza Vaez Mahdavi, Sarah Mahboubi, Fatemeh Moradi, Ehsan Kazemi Moghaddam

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 1 (2017), , Page 3-8

Background &Objectives: High fat (HF) diet by affecting the oxidative stress and nitric oxide (NO) production may lead to different effects on function of the heart after myocardial infarction (MI). In the present study we aimed to address the hypothesis that high release of NO by activated macrophages affects LV function after MI.

Methods: The animals were randomly divided into four groups comprising each of 10 rats: 1) Sham; 2) MI; 3) Sham+ HF diet; 4) MI+ HF diet. Animals fed with HF diet 30 days before sham and MI surgery. MI was induced by permanent ligation of left anterior descending coronary artery (LAD). Nitric oxide (NO) production of peritoneal macrophages, the concentrations of MDA in the heart and the infarct size were measured.

Results: Our study indicated that HF has adverse effects on myocardium and it may increase NO production as well as oxidative stress, resulting in augmentation of infarct size.

Conclusion: Our results add to our knowledge that HF diet was associated with overproduction of NO by peritoneal macrophages and ROS that lead to development of infarct size and adverse remodeling.

Effects of magnesium on clinical outcome of critical care traumatic patients

Seyed Muhammad Nasir-al-din Tabatabaei, Alireza Jahangirifard, Mehrnegar Safarzaei, Majid Golestani Eraghi, Maziar Mahjoubifard

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 1 (2017), , Page 9-14

Background: Magnesium (Mg) is a necessary element in a vast number of enzymatic paths throughout the body, so, its cellular mechanisms affect clinical outcome; it is also the main second intracellular cation playing a crucial role in ATP/ADP energy conversion. Lack of Mg is usually reported in 10% of hospitalized patients worldwide. Chronic hypomagnesaemia is also in correlation with many chronic pathologic conditions. The present study was designed to assess the correlation of the serum level of Mg in ICU admitted patients with their prognosis.Materials and Methods: Through a retrospective cross-sectional design, 180 ICU admitted patients over 18 years, between 2012 and 2014 were enrolled in the study; 90 had normomagnesemia and 90 hypomagnesaemia. APACHE II score was calculated for patients after 24 hours of admission in ICU before measuring serum Mg level of each patient. Then, patients' outcomes were assessed. Mortality, hospital stay, requirement for mechanical ventilation and duration of mechanical ventilation were recorded.Results: Out of total patients with normal serum Mg 22 (22.4%) died while 36 (40%) died with hypomagnesaemia. There was no significant difference between the groups for the length of hospital stay. 48.9% of total patients with normal Mg who were admitted in ICU needed ventilator, but 78.9% of hypomagnesaemia cases were to use ventilator who were significantly higher than the other group. In terms of the time of ventilator use, a significant difference was seen between the patients with normal or low serum Mg. Individuals with normal Mg needed more days of ventilation, interestingly (26.5 vs. 17.5 days).Conclusion: Low serum magnesium could be a key factor for assessing prognosis among ICU admitted patients, especially in critically ill ones.  


Brief Communications

Crouzon Syndrome: a fibroblast growth factor receptor 2 gene mutation

Farhad Safari, Kamran Mottaghi, Rofeideh Fallahinejadghajari, Masoud Nashibi

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 1 (2017), , Page 15-18

Crouzon syndrome is a rare autosomal dominant premature cranyosynostosis, caused by fibroblast growth factor receptor 2 gene mutation on chromosome 10. The predominant skull and facial malformations with potential compromise airway make the crouzon syndrome a demanding issue for anesthesiologists and surgeons, required dynamic team work. In this report we describe a child, a known case of Crouzon syndrome who was a candidate for optic nerve decompression through endoscopic surgery. The anesthetic considerations and management are presented.

Key words: Crouzon Syndrome, FGFR2 gene, Difficult Intubation, Anesthesia


Genetic Risk Factors for Inhibitor Development in Patients with Hemophilia and Rare Bleeding Disorders

Taregh Bamedi, Ghazaleh Dadashizadeh, Afsaneh Sarabandi, Shadi Tabibian, Mahmood Shams, Akbar Dorgalaleh

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 1 (2017), , Page 19-23

Inhibitor development is a lifelong challenge for patients with bleeding disorders who received replacement therapy. Most commonly, inhibitor formation was observed in hemophilia A patients but patients with rare bleeding disorders (RBD) especially patients with deficiency of factor XIII (FXIII) and factor V (FV) can develop an inhibitor against exogenous factors. Several factors considered as risk factors for inhibitor formations in these patients. Genetic risk factors are the main accused that can cause inhibitor formation in hemophilia patients but are less important in RBDs.

For this review study, we searched MEDLINE and Web of Science databases for English sources and the following key words: hemophilia, inhibitor, rare bleeding disorder, rare inherited disorder, acquired hemophilia, acquired rare bleeding disorders, treatment complication, genetic in hemophilia, polymorphism in rare bleeding disorder, mutation in hemophilia and other required keywords.

Hemophilia A (HA) patients who had large deletion, nonsense mutation or intron 22 inversion are more susceptible for inhibitor development. Gene polymorphisms in immune system are also considered as other risk factors in HA patients.

Keywords:  Hemophilia, rare bleeding disorder, inhibitor

The role of Toll-like receptors in pain control

Parissa Sezari

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 1 (2017), , Page 24-29

The Toll like (family of receptors TLR) are expressed primarily by immune cells and are known to be part of innate immune system. In the past decade involvement of TLRs in several physiologic and pathologic pathways has been proved. Pain transmission via glial activation is one of such interesting fields. Both pathological pain states and treatment have also been shown to be related to TLR-related pathways. Opioid agonists are found to possess TLR4 agonistic effects and glial activity. Targeting TLRs could be a novel method for treatment of neuropathic pain. Moreover attenuation of glial activation by the aim of selective TLR antagonistic drugs, may become a preferred way of separating the beneficial (analgesia) and unwanted effects of opioids, improving their safety and efficacy.

The molecular mechanisms of Vitamin D effects on alleviating premenstrual syndrome pain

Samira Rajaei, َAli Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 1 (2017), , Page 30-36

Premenstrual syndrome (PMS) is a hormone dependent pathophysiologic state with known somatic and affective symptoms. Vitamin D3 as a secosteroid hormone has different effects on several disorders. In this review, we declared some potential benefits of vitamin D3 regarding alleviation of PMS symptoms; also, we have reported the results of literature review about vitamin D and PMS.