Original Articles

Effect of Intraarticular injection of ozone on inflammatory cytokines in knee osteoarthritis

Masoud Hashemi, Seyed Mehdi Hoseini Khameneh, Peyman Dadkhah, Seyed Amir Mohajerani

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 37-42

Introduction: Knee Osteoarthrosis is one of the most debilitating diseases. Prolotherapy includes intraarticular injection of various drugs to decrease inflammation. Injection of Intradiscal O2-O3 has reduced pain and disability of patients with low back pain due to prolapsed lumbar disk.
Objective: To compare the effect of intraarticular injection of Ozone and steroids in improvement of clinical and cellular healing of knee osteoarthritis.
Methods: in a randomized clinical trial, 70 patients with knee osteoarthrosis were included in the study. In Ozone group, 5 ml (35 μg/ml) of Ozone and in steroid group 5ml (50 mg) Triamcinolone were injected intraarticular. At 1,2,and 6 month patients were followed for pain scale, disability index and IL-1β and TNF-α serum levels were measured.
Results: At 1 month after injection pain scale and disability index and IL-1β and TNF-α were decreased in both groups. However, at 2 and 6 month pain scale and disability index were significantly lower in Ozone group compare to steroid group (p<0.05). Besides, serum level of IL-1β and TNF-α were also significantly lower at 2 and 6 month in Ozone group compare to steroid group (p<0.05).
Conclusion: Intraarticular Ozone induces significantly longer improvement of pain and disability in knee osteoartherosis compare to steroid injection. In addition, serum inflammatory cytokines are also lower in Ozone group compared to steroid group along with clinical improvements.


Introduction:Chronic radicular pain is often treated by epidural steroid infiltration (ESI). In 2014, Food and Drug Administration (FDA) issued a letter warning that ESI may result in rare but serious adverse events, including “loss of vision, stroke, paralysis, and death”. In this retrospective study, we compare retrolaminar paravertebral infiltration (PVI) of a non-steroid-mixture with ESI.

Method:  We identified 31 patients registered in the Quebec Pain Registry suffering from chronic lumbar or cervical radicular pain referred to the Centre Hospitalier de l’Université de Montréal (CHUM) pain clinic between 2009 to 2014. These patients received ultrasound-guided retrolaminar PVI with a mixture of morphine 1 mg, ketamine 10 mg, neostigmine 0.5 mg, naloxone 2 ng, and bupivacaine 10 mg. The control group, matched for gender, age, and DN4 sub-scale score at baseline, consisted of 31 patients with the same pathology; they were treated by fluoroscopic-guided ESI. Principal pathologies in both groups were disc disorders and/or foraminal stenosis. All patients received only one infiltration during the six months following the initial visit. The numerical rating scale (NRS-11) was assessed at the first visit and six months later. The BPI, PCS and SF-12 were compared in both groups. Overall satisfaction in pain relief after six months was assessed with a scale of 1 (very unsatisfied) to 6 (very satisfied).

Results: Average NRS-11 scores for the seven days preceding the first visit and after six months were compared in both groups. The same comparison was made for overal1 treatment satisfaction. There is no significant difference in the NRS-11 and in the satisfaction scores between the two groups.

Discussion/conclusion: Neither of the two methods was shown to be superior to the other in pain relief and overall treatment satisfaction after six months. Considering the possible complications and side effects of ESI, PVI with a non-steroid mixture might be considered as an alternative method. Possibly, multiple PVIs could further decrease pain. Well-designed studies are needed to evaluate this hypothesis.

Effect of Ketofol instead of Propofol on hemodynamic stabilization for induction of Anesthesia in Laparatomy

Hamid Kayalha, Mohammad Kolahdoozha, Siamak Yaghoobi, Marzieh Beygom Khezri, Seyed Amir Mohajerani, Alireza Jahangirifard

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 50-54

Introduction: Hemodynamic alterations are a common complication during anesthetic induction with intravenous anesthesia. Hypotension due to propofol injection may be very severe in cardiac vascular patient. Ketamine produces the significant increasing but temporary in systematic blood stream, heartbeat, cardiac output through central sympathetic stimulation.

Objective: To determine effect of ketofol and propofol for induction of anesthesia on hemodynamic changes during induction of anesthesia

Methods: In a randomized cinical trial study 96 patient who were candidate for laparotomy enrolled and divided into two random group of propofol (48 person) and ketofol (48 person). Hemodynamic changes were recorded and examined after induction, after intubation and 5 and 10 minutes after intubation.

Results: Heart rate was significantly variable in propofol group compare to ketofol group. Systolic, Diastolic, and mean arterial blood pressure was not significantly changed during time period of recording in ketofol group. However, blood pressure was significantly changed during the study in propofol group.

Conclusion: ketofol is a proper alternative to propofol to stabilize heart rate and blood pressure in laparatomy.

Predictor factors for sepsis diagnosis, length of ICU stay and mortality in ICU

Behrooz Farzanegan, Mahdi Zangi

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 55-62

Introduction: In a prospective study, we aimed to assess the value of enhanced RDW to predict sepsis and evaluate factors affecting length of ICU stay and in-hospital mortality among sepsis patients. Material and Method: After exclusion of 27 patients, we included 160 adult patients with suspicious sepsis admitted at university affiliated Hospital with 33 ICU-beds from 2010 to 2012. Nighty patients were diagnosed with sepsis and the source of infection was defdined. Receiver–operating characteristic (ROC) curves were used to examine the sepsis predictions from RDW, APACHE II scores, and combination of them. The primary endpoint of this analysis was ICU mortality. The secondary endpoints were length of stay at ICU and hospital.A linear regression analysis was used to study risk factors for longer ICU stay and we used Logistic regression analysis to predict factors affecting in-hospital mortality. Results: The addition of elevated RDW value to APACHEII score in critically illness states enhanced the AUC for predicting sepsis and its differentiation from SIRS.Female patients and those with numerous co-morbidities or AKI and those on mechanical ventilation significantly stayed longer at ICU. Moreover, the patients with higher APACHE II score died significantly more than others. Conclusion: The addition of elevated RDW value to APACHEII score in critically illness helps to differentiate sepsis from SIRS. Key words: Red blood cells distribution width, Intensive Care Unit, Factor

Brief Communications

Anesthetic management of patients with Klippel-Feil syndrome, a case series

Kamran Mottaghi, Farhad Safari, Parisa Sezari, Naeime Gholizadeh, Masoud Nashibi

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 63-68

Introduction: Klippel feil syndrome (KFS) is a rare entity which is characterized by failure of normal segmentation of cervical vertebrae resulting in short neck with restricted movement and cervical instability. This anomaly increases the risk of neurological damage during airway instrumentation like laryngoscopy and positioning for surgery.

Case Rports: We report three patients, a 42 year old male patient with KFS who scheduled for craniocervical fusion under general anesthesia and a 6 year old girl candidate for cleft palate repair and a 26 year old woman candidate for craniocervical fusion.

Conclusion: All the cases were successfully managed using fiberoptic bronchoscope in first two cases and gum elastic bougie (GEB) in the last case. All things together, Awake fiberoptic intubation could be the safest technique for airway management.


Anesthetic considerations in medium-chain acyl-CoA dehydrogenase deficiency

Lisa A Caplan, Mary (Toni) A Felberg

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 69-76

In the 1980’s, medium-chain acyl-CoA dehydrogenase deficiency (MCADD) was first described in the literature as three children who presented with coma, hypoglycemia, hyperammonemia, and fatty liver while fasting. These symptoms while similar to Reye’s Syndrome, were found to be due to an inability to metabolize medium chain fatty acids during fasting periods. Fatty acids are utilized by the body asessential fuel for skeletal and cardiac muscle, and as an important source of energy during fasting periods. Medium-chain acyl-CoA dehydrogenase is a mitochondrial enzyme required for the beta oxidation of medium chain fatty acids (C4-14), which is deficient in this syndrome. Anesthesiologists may come across these patients in their practice, as MCADD is the most common inhertited disorder of mitochondrial fatty acid oxidation. In addition to determining NPO timing and IV fluid selection, other preoperative issues anesthesiologists must consider are medication management to avoid metabolic decompensation. This manuscript will consider a pediatric patient with MCADD who presented to our pediatric hospital and received a general anesthetic following the guidelines created by ourmultidisciplinary perioperative team.

Sleep and anesthesia: can we use a physiologic model to decrease risks of a medical intervention

Ali Dabbagh, Samira Rajaei

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 77-81

Anesthesiology is one of the most important creations of the modern science, basically based on the anesthetic drugs; however, there are a few concerns regarding the effects of the anesthetic drugs. Would there be any progress in the current trend of anesthesiology, both clinically and basically. There would be a possibility to use the physiologic mechanisms of sleep to be incorporated into clinical practice instead of pharmacologic agents in order to decrease their unwanted effects.

Cellular and Molecular Mechanisms in Perioperative Hepatic Protection: A Review of Current Interventions

Zahra Talebi, Hassan Peyvandi, َAli Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 2 No. 2 (2017), 12 May 2017 , Page 82-93

Liver is one of the most important organs needing great concern during the perioperative period. There are a number of different mechanisms that interact with liver cells and might affect their integrity and cell live. Though these mechanisms are not all the same, there is a great common point: all affect the metabolic pathways of the liver. Ischemia, anesthetic drug effects and other perioperative insults may affect the liver. Disturbance in an organ’s blood flow is an inherent part of diverse surgical procedures, which leads to lack of oxygen and nutrient supply. These ischemic periods can be particularly long in case of liver surgeries, such as resection of large hepatic tumors, management of hepatic trauma and liver transplant. Once the blood flow and oxygen supply are restored, the interruption of blood flow affects the oxygen dependent cells in liver, which require mitochondrial oxidative phosphorylation for their metabolism. Molecular mechanisms such as Redox status, ionic interchange disturbances as well as different mediators and cells like KC, SEC, dendritic cells, leukocytes, and lymphocytes, are involved in the process ultimately leading to cell death by apoptosis and necrosis. This review provides an overview on the cellular and molecular mechanisms involved in liver injuries, categorizing these mechanisms in 3 different classes: preoperative mechanisms, intraoperative mechanisms and postoperative mechanisms. Each of them are discussed in a different part of the manuscript