Stress Response Reduction: A Prospective Strategy in Anesthesia

Parissa Sezari

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 87-88

Since the first laparoscopic surgery on human in 1980s, the potential for manipulating the inflammatory and metabolic response to surgical trauma has been put into debate (1-5). Many physicians suggest that laparoscopic interventions are better called as “minimally invasive surgeries”, as in actuality they pose less “invasion” to the tissue, which is analogous to diminished inflammatory harmful mediators (4, 6, 7).
Surgical stress response includes endocrine, immunologic and hematologic regulations following tissue injuries made through procedures. These metabolic changes, protective in nature for the human organs, can result in deleterious effects when exaggerated (8).
Does the anesthesia techniques or drugs have the capability of altering the perioperative stress responses? Such question brings up vast fields to work on.
Cakmakkaya and colleagues analyzed available data on the effect of different anesthesia techniques on recurrence of malignant tumors (9). This cochrane-based systematic review concluded that the existing data is not adequate to choose either the general anesthesia or regional techniques as the optimum method to prevent progression of malignancy. Also, a new role is introduced for the anesthesiologist in perioperative patient care.
In Addition, studies have been conducted to control the surgical stress regulations and immune functions in the postoperative period. Pain relief and its beneficial outcomes on inflammatory and oxidative stress is fairly discussed (10). Although epidural anesthesia is known as one of the efficacious techniques in this era (11), the different efficacy of variable nociceptive inhibition techniques (12) and drugs (such as volatiles, dexmedetomidine and other intravenous hypnotics) are not fully assessed yet (13, 14).
However, pain is not the only anesthesia-related subject to be concerned about (15, 16). In the current volume of this journal, Vosoughian et al. have propounded the difference of spinal vs. general anesthesia on attenuating the increased cytokine levels in preeclamptic expectant mothers (17) .The reported decrease in interleukins 6 and 10 demonstrates the favorable influence of spinal anesthesia in controlling the inflammatory anomalies available from before, while the net effects in other pathways such as hormonal or oxidative stress chains are yet to be examined. Moreover, other surgical procedures or pathological conditions may introduce different patterns of mediator elevation partially understood by now, which dictate further well-designed randomized trials to answer the dilemma (18).

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Original Articles

The Effect of Spinal and General Anesthesia on Cytokine Serum Levels Following Cesarean Section in Preeclampsia

Maryam Vosoughian, Mastaneh Dahi-Taleghani, Mohammadreza Moshari, Samira Rajaei, Shima Rajabi, Farinaz Taheri

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 89-97


Background: The purpose of this study is to investigate the impact of different anesthetic techniques on the release of cytokines interleukin IL-6, IL-10 and tumor necrosis factor (TNF)-α in preeclampsia patients who undergo cesarean section.Materials and Methods: In the study 40 patients were enrolled with preeclampsia undergoing cesarean section, allocated into two equal groups to receive either general anesthesia (n = 20) or spinal anesthesia (n = 20). Non-invasive hemodynamic monitoring was used. Serum levels of IL-6, IL-10 and TNF-α were measured before and at the end of surgery.Results: There was no significant rise in serum levels of TNF-α in general anesthesia while IL-6 and IL-10 serum levels increased significantly. Also, compared with patients anaesthetized with general anesthesia patients who received regional anesthesia notably had lower levels of IL-6 and IL-10 after surgery (p < 0.05).Conclusion: Spinal anesthesia causes significant difference in post-operation IL-6 and IL-10 serum levels in preeclampsia patients undergoing cesarean section. Nevertheless, neither general nor spinal anesthesia made such effect on serum level of TNF-α. Further studies with higher sample size and comparing preeclamptic patients to healthy mothers undergoing cesarean section are required.

The effect of 1,25 (OH)2 Vitamin D3 on serum levels of inflammatory cytokines in patients undergoing CABG

Kamal Faani, Mahdi Shadnoush, Alireza Jahangirifard, Mahnoosh Foroughi, Hosein Ali Jelveh-Moghaddam, Ali Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 98-102

Introduction: a number of preventive or therapeutic strategies have been proposed to compensate for the inflammatory process during adult cardiac surgeries; none have been considered definitive. 1,25 (OH)2 Vitamin D3 is among the so called physiologic hormones with immunomodulatory effects. This study assessed the effect of oral Vitamin D on serum levels of IL-1, IL-6 and TNF-α in adult CABG.

Materials and methods: in a double blind placebo controlled clinical trial, 80 patients entered the study after qualifying study criteria; being divided to Vitamin D and placebo groups, serum cytokines (IL-1, IL-6, and TNF-α) were measured preoperatively and also during the 1st day after the operation.

Results: serum TNF-α levels were similar in the 2 groups; however, postoperative levels of IL-1 and IL-6 were significantly lower in Vitamin D group.

Conclusion: the current study demonstrated that oral Vitamin D supplements could augment immunomodulatory effects in adult patients undergoing cardiac surgical procedures (mainly CABG).

Keywords: Vitamin D, Cardiopulmonary Bypass, Cytokine, Inflammation

Epidural Anesthesia with Lidocaine and Dexmedetomidine, Versus Lidocaine Alone on Plasma Levels of IL-6 in Patients with Proximal Femoral Fracture.

Mohammadreza Moshari, Bahman Malek, Adel Ebrahimpour, Maryam Vosoughian, Mastaneh Dahi-Taleghani, Ehsan Ghorbani, Seyed Mohammad Seyed-Alshohadaei

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 103-107

Interleukin-6 plays an important role in inflammatory responses and synthesis of acute hepatic phase proteins and its plasma level changes are used as a reliable prognostic factor for mortality in hospitalized patients. On the other hand, various methods for reducing inflammatory responses, including proper control of pain during and after surgery, and correction of hemodynamic disorders, can be monitored by monitoring of plasma levels of IL-6. Epidural anesthesia is an appropriate method for controlling pain in lower limb surgeries. The aim of this study was to evaluate the effect of adding Dexmedetomidine to lidocaine in the epidural injection for better control of post-surgical inflammatory responses by measuring interleukin-6 plasma levels.

Patients referred to Taleghani Hospital in 1396 who suffered from lower limb fractures and requiring surgery were evaluated. 52 patients in two groups receiving Dexmedetomidine doses of media and controls for the quality of epidural anesthesia and IL-6 index. After obtaining written consent, the Dexmedetomidine treatment group and the normal saline control group were prescribed epidural with lidocaine. Finally, the level of IL-6 before surgery and 6 hours after surgery were evaluated.

According to the results of statistical analysis, the two groups did not show a significant difference in age and level of interleukin prior to the operation. The mean age of patients in this study was 15.84639 ± 53.4038. The sex distribution of the study included 19 women (36.5%) and 33 men (63.5%). According to the U Mann Whitney test, the second injection time and total drug volume had a significant difference between the control and intervention groups and Dexmedetomidine reduced the volume of total drug needed and increase the time interval until the second injection (p <0.001). There was also a significant difference between the two groups in the level of interleukin 6 after 6 hours of operation and this was lower in the Dexmedetomidine group.

keywords: Interleukin-6, Dexmedetomidine, lidocaine, Anesthesia

The Effect of Pulsatile Blood Flow During Proximal Graft, on Liver Function in Coronary Artery Bypass Graft Surgery

Seyed Mohammadreza Amouzegar Zavareh, Marzieh Lak

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 108-113

Background: Liver dysfunction is a rare complication with high mortality and morbidity in coronary artery bypass grafting (CABG) surgery. Pulsatile blood flow probably maintains liver function during cardiopulmonary bypass (CPB).

Methods: In this randomized clinical trial study, 68 patients who were underwent CABG surgery divided in two groups: pulsatile and non-pulsatile groups. We transferred continuous blood flow to pulsatile blood flow during proximal graft by using cardiac contraction.

Results: There was not significant difference in serum-alanine-aminotransferase (SGPT) and alkaline phosphatase (ALP) values at variable times in two groups. In addition, the procedure of SGPT and ALP in the case and control groups was not significantly different in three days. There was not significant difference in serum glutamic oxaloacetic transaminase (SGOT) values at variable times in two groups. However, the procedure of SGOT in the case group was significantly increased and in control group was not significantly different in three days.Conclusion: we conclude that hemodynamic stability is more important than type of blood flow in maintaining liver function.

Keywords: pulsatile perfusion, cardio pulmonary bypass, liver function

Preventive Effect of Paracetamol and Dexamethasone on Nausea, Vomiting, and Pain after Laparoscopic Cholecystectomy

Reihanak Talakoub, Gholamreza Khalili, Babak Haghanifar

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 114-121

Background: The currently used antiemetic drugs are not effective in all post-operative patients due to multifactorial origin of nausea and vomiting. Therefore, the present study was designed to evaluate the preventive effect of paracetamol on postoperative nausea and vomiting (PONV) in comparison with dexamethasone in patients undergoing elective laparoscopic cholecystectomy.Materials and Methods: in this double-blinded clinical trial 105 patients were selected using a random sampling method; they were American standards association (ASA) class I and II, 18-75 years and candidate for laparoscopic cholecystectomy; randomly assigned into three groups: Paracetamol, Dexamethasone, and control. They were anesthetized using the same method, using sodium thiopental, Fentanyl, Atracurium, and Lidocaine. Anesthesia was maintained with oxygen, Isoflurane and Morphine. They also received 6 mL/kg/h ringer lactate. Patients data were recorded and analyzed.Results: The mean severity of nausea and vomiting in the recovery room at minutes 30, 45, and 60 had a significant difference between the groups (p<0.05). The satisfaction score at minutes 45 and 60 had a significant difference between the groups (p<0.05). However, the mean scores of satisfaction of patients at 15 and 30 minutes were almost the same and no significant difference between the three groups was reported  (p>0.05).Conclusion: The severity of nausea and vomiting was low in the Paracetamol group and Paracetamol was more effective than Dexamethasone in terms of reducing the rate of nausea and vomiting.

Keywords: Paracetamol, Dexamethasone, laparoscopic cholecystectomy


The Balance between Pro-oxidants and Antioxidants in Cardiac Anesthesia: a Review

Seyed Mohammad Seyed-Alshohadaei

Journal of Cellular & Molecular Anesthesia, Vol. 3 No. 3 (2018), 4 November 2018 , Page 122-125

Due to the development of surgical techniques for controlling the conditions of patients, we are still faced with many conditions and risks in the management of patients' health during and after surgery. Hence, the creation of new methods, access to medicines and things that increase the quality of management and improve patient control conditions are on the agenda of many research teams around the world. Antioxidant substances and their effects on the control of free radicals (as one of the destructive factors on the health of patients undergoing surgery) is one of the research cases that has attracted many researchers in recent years. Cardiac surgery and cardiac anesthesia are among the most challenging types of surgeries. Control and management of patient conditions during this type of surgery is one of the most important challenges of anesthesiology team. This study tries to investigate the importance of antioxidants in controlling conditions and improving the status of patients undergoing cardiac surgery.

Keywords: Antioxidant; Pro-oxidant; Cardiac Anesthesia; Inflammation