Original Articles


Effect of bupivacaine and combination with dexmedetomidine and dexamethasone on mice neural apoptosis

Mohammadreza Moshari, Ali Dabbagh, Mastaneh Dahi, Maryam Vosoughian, Behnam Hosseini, Fereshteh Baghizadeh, Seyed Mohammad Seyed -Alshohadaei

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 3 (2019), 28 January 2020 , Page 69-74
https://doi.org/10.22037/jcma.v4i3.28282

Background: Numerous studies have shown the neurotoxicity of anesthetic substances in different age groups. This toxicity is often associated with damage or apoptosis of nerve cells that can lead to various diseases, including Alzheimer's, behavioral changes and transient and even persistent cognitive changes. In this study, it was attempted to evaluate the cytotoxic conditions following the use of three common anesthetic drugs (bupivacaine, dexmedetomidine and dexamethasone) by providing a suitable substrate.Methods and Materials: Mice (Mus musculus) with the same weight (22 to 30 gr) were used for assessment of neurotoxicity in Bupivacaine, Dexmedetomidine and Dexamethasone. Unilateral femoral nerve injections were done; animals were randomly divided into four groups: control, bupivacaine alone, "bupivacaine + dexmedetomidine" and "bupivacaine + dexamethasone". After 24 hours, the mice were sacrificed and the femoral nerve removed. Hematoxylin-eosin tissue staining was used to evaluate changes in the effects of the drugs, and nerve samples were extracted to assess the expression of TLR4 and caspase3. Protein expression level was checked between different groups using Western blot technique.Results: The bupivacaine + dexamethasone group showed better outcomes in terms of cytotoxicity than bupivacaine + dexmedetomidine (p=0.568); also, bupivacaine + dexamethasone reduced neurotoxicity risk (P=0.431).Conclusion: Bupivacaine+dexamethasone leeds to better outcomes in terms of neurotoxicity compared with bupivacaine+dexmedetomidine.

Relationship between Head and Neck Anthropometry in Sonographic Assessment of the Corner Pocket for Ultrasound – Guided Supraclavicular Plexus Blocks

Behnam Hosseini, Shideh Dabir, Faramarz Mosaffa, Seyed Mohammad Seyed Alshohadaei, Fereshteh Baghizadeh

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 3 (2019), 28 January 2020 , Page 75-81
https://doi.org/10.22037/jcma.v4i3.25869

Background: supraclavicular approach has steadily grown throughout various surgeries as a regional anesthesia technique. Ultrasound is suggested to increase the accuracy and safety. This study was aimed to assess the relationship between effectiveness of head and neck anthropometry and sonographic supraclavicular angle as a safety measure.Methods and Materials: 34 patients were evaluated using an ultrasonography device with a linear probe to assess angle of measurement. Besides, using metric measurements, head and neck anomalies were examined. Pearson coefficient analysis was used for data analysis.Results: Based on the results of this study (Table 2), except for age, gender and neck width of the patients, the results did not show a significant relationship. Also, regression calculation studies clearly indicated a higher correlation and alignment of factors such as width, length and circumference long distance in comparison with short distance.Conclusion: The result showed that there was a correlation between the studied angles and the factors of the study with more emphasis on the effective role of ultrasound in the process of anesthetizing the patient through supraclavicular.

Evaluation of outcome in sticking upper limit and lower limit in BIS monitoring for radical cystectomy

Nilofar Massoudi, Mohammad Fathi, Navid Nooraei, Moien Daneshmand

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 3 (2019), 28 January 2020 , Page 82-87
https://doi.org/10.22037/jcma.v4i3.27580

Introduction: The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy.  The purpose of this study is to evaluation of outcome in sticking upper limit and lower limit in BIS monitoring for radical cystectomy surgery.

Methods: 202 patients with elective radical cystectomy were selected randomly and divided into two groups of BIS (40-50) and BIS (50-60). The patients were blinded to the study group (BIS). Initially demographic and clinical information such as age, sex, weight, recovery time, patient extubation time, awareness during surgery, mortality rate and patient stay in hospital, BIS and patient cost were included in data collection form.

Results: There were 197 males and 5 females and the average age of the patients were 67.12±8.1. There is significant relationship between recovery time, amount of anesthetic used,  ICU stay, hospital stay, hospital cost, and BIS monitoring range.(p value<0.001). Also there is significant relationship between extubation time and BIS monitoring range. (p value=0.001). The relationship between PONV with BIS monitoring range is significant. (p value<0.001). But there was no significant relationship between Analgesic drugs (p value=0.26) and awareness (p value=0.175) and mortality (p value=0.651) with BIS monitoring range.

Conclusion: The conclusion is that by increasing the BIS value, the anesthetic dose, extubation and recovery time, hospital and ICU stay were significantly reduced as well as the cost.

Background

This study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity.

Settings and design

 The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine + 4 mg/kg ondansetron, and group M lidocaine + 7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests.

Results

The time for onset of sensory and motor blocks in group M was significantly shorter than the groups C and O (P <0.05). In terms of the recovery time of sensory block, the time of group O was significantly longer than those of groups M and C (P <0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than those of group C (P< 0.05). No significant difference was observed in postoperative pain and other features among the groups (P >0.05).

Conclusion

Magnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required.

Brief Communications


Cardiac surgical procedures are among the most complex operations with a detailed list of perioperative care. Weaning from CPB is associated with a number of disturbances in cardiac rhythm. One of the most challenging cardiac rhythm disturbances is the ventricular arrhythmia (tachycardia/fibrillation). Cardioversion and antiarrhythmic agents may be ineffective after aortic declamping; systemic hyperkalemia may be a therapeutic option. Here, we review the available studies regarding this issue and the possible underlying mechanisms of this therapeutic approach.

The role of connective tissue genomics in ascending aortic dissection: A case of Marfan syndrome

Firoozeh Madadi, Manouchehr Hekmat, Zahra Ansari Aval, Abdolhamid Bagheri, Kamal Fani, Mohammad Hosein Ghanbarpour, Maryam Hamidzad, Mehrubon Murodov, Ali Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 3 (2019), 28 January 2020 , Page 100-104
https://doi.org/10.22037/jcma.v4i3.28189

Background: Aortic dissection is a rare yet life threating condition with some already discovered risk factors namely hypertension, connective tissue disorders such as Marfan syndrome (MFS), cocaine abuse and cigarette smoking.Case report: In this article we would like to present a case of MFS who presented with severe chest pain and undergone Bentall surgery due to aortic dissection and aneurysm.Conclusion: Although many risk factors and preventive measures are already investigated, there is no definite method to avoid its occurrence in genetically predisposed patients such as MFS. Patient-specific models utilizing embryonic stem cells (ESC) and induced pluripotent stem cells (iPSC) may offer some advantages.