Journal of Cellular & Molecular Anesthesia

Although the three viruses corona viruses (SARS-CoV: 2003, MERS-CoV: 2012 and SARS-CoV-2: 2019) have similarities especially regarding clinical features, there are key differences between them that limit the relevance of experiences from previous crises. Regarding treatment in the absence of vaccine, it is recommended an the first stage to use pharmaceuticals and their combinations (protease inhibitors, interferon compounds, antiviral antibodies) aiming to suppress diverse targets during virus propagation and during the second disease stage, it seems crucial and reasonable to rely on administration of pathogenetic drugs to restrict life threatening events resulting in marked inflammation, intoxication, hypoxia and infection. The most important method to prevent viral zoonosis is to maintain the barriers between natural reservoirs and human society.

Background: Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) surgery, and is associated with major adverse outcomes. Effect of preoperative administration of coenzyme Q10 was evaluated in order to realize that whether it could prevent the occurrence of AKI following elective CABG surgery. Materials and Methods: Two hundred and fifty patients who were candidate for elective CABG surgery between September 2017 and August 2018 were randomly assigned to intervention group (receiving coenzyme Q10, 300 mg BID for 2 days before surgery) and control group. Serum NGAL (neutrophil gelatinase-associated lipocalin) was measured at baseline, 6 and 24 hours after surgery. Serum creatinine (sCr) and urine output (UO) were also measured at baseline and after surgery. Results: Fifty patients completed the study. The total incidence of acute kidney injury was 32%. There were no significant differences in the incidence of AKI (p=0.07) between the two groups. Serum NGAL was shown no significant difference at 6 (p=0.13) and 24 (p=0.22) hours after surgery compared to the baseline level between the two groups, whereas, the significant difference in the hospitalization duration was shown between them (p=0.02). Conclusion: CoQ10 supplementation did not significantly decrease the incidence of AKI in patients undergoing elective CABG.

Background: To investigate the effects of vitamin D3 on the surgical outcome of pediatric patients undergoing cardiac surgery for congenital heart conditions. Materials and Methods: Ninety pediatric cardiac surgery patients referred for preoperative evaluation were enrolled. Patients with insufficient vitamin D3 levels received intramuscular vitamin D3 (300,000 IU) three days before the surgery and those with final vitamin D3 level of ≥30 ng/dl were included and divided into 3 groups (Group A: abnormal Vit D levels, no Vit D treatment; Group B: abnormal Vit D levels, Vit D treatment up to normal serum Vit D levels before surgery; Group C: normal baseline Vit D levels, no supplemental Vit D treatment). Interleukin 1, 6, 10, tumor necrosis factor-alpha, vital signs, and arterial blood gas parameters were measured before the surgery and at 6 and 24 hours after cardiopulmonary bypass. Data on total hospital stay, reoperation rates, and inotropes scores were retrieved. Additionally, postoperative measures including hemodynamic factors, blood pressure, heart rate, cardiac output, electrocardiography changes, chest-tube drainage, and ventilation-related factors (i.e. respiratory rate, arterial blood gas, respiratory resistance, intubation time, …) were recorded. Results: We observed a significant increase in post cardiopulmonary bypass levels of IL-10 and IL-6 in all groups (p<0.002) regardless of vitamin D treatment status; however, no significant difference was seen in levels of IL-1 and TNF-alpha. Groups B had more patients with critical levels of VIS scores compared to groups A and C (p<0.002). Furthermore, no differences in hemodynamic and metabolic parameters were observed. Conclusion: No significant difference in the rates of postoperative parameters in patients with normal and those with deficient levels of vitamin D3 was observed.

Background: Frozen shoulder is a common cause of shoulder pain and disability. Several treatments are utilized to reduce patients' pain and improve range of motion (ROM). Recent researches have been conducted on Platelet-rich plasma (PRP) injection. In this study, the clinical results of PRP injection for patients with frozen shoulder was assessed. Materials and Methods: Forty-four patients in phases I or II of frozen shoulder were treated with PRP. During the first session, two syringes of PRP were injected in the subacromial bursa and intra-articular space; this process was repeated after four weeks. In the second stage, PRP was injected only in the glenohumeral joint. Results: The average pre-treatment flexion was about 65°; abduction was 70°while external rotation was 22°. Also, baseline scores for VAS, DASH, and SF-12 Health Survey questionnaire were 8.4, 65.9 and 26, respectively. After 25 weeks follow-up, all patients showed significant improvement in shoulder ROM, pain, and function (p˂0.001). Patients reported 66.7% improvement in pain, 51.6% in DASH score, and 100% in SF-12 Health Survey questionnaire. They were also 65% satisfied with the treatment protocol. Conclusion: This case series study demonstrated clinically and statistically significant improvement in patients' pain and disability outcomes following PRP injection. These results provide support for PRP as a safe treatment protocol that decreases pain and increases upper limb function. In addition, it can also improve shoulder range of motion.

Background: One of the objectives of a smooth laryngoscopy is to minimize hemodynamic changes. The goal of this study was to assess the effects of dexmedetomidine and labetalol on heart rate and blood pressure changes after laryngoscopy compared to a control group. Materials and Methods: This was a double-blind clinical trial conducted on 120 patients aged between 18 and 60 years, who were candidates for surgery, under general anesthesia, at Alzahra hospital in Isfahan during 2017-2018. Patients were randomly allocated to three groups of being administered dexmedetomidine or labetalol and a control group. The patient's age, weight, height, gender and clinical data including mean blood pressure (BP), heart rate, systolic BP, diastolic BP and oxygen saturation during 1, 3, 5 and 10 minutes after intubation were collected and analyzed using repeated measure analysis. Results: The average age of patients who were candidates for surgery was 42.62 +/- 1.40. 52 percent (63 patients) were male subjects. The results showed no significant difference in mean BP, diastolic BP, systolic BP or oxygen saturation (p>0.05) in the three groups. But the difference in heart rate between the three groups was statistically significant. The heart rate in the dexmedetomidine group was significantly lower than the labetalol and control groups (p=0.00). Conclusion: Results of the current study showed that using labetalol provided desirable hemodynamic stability compared to dexmedetomidine and caused less hemodynamic disturbances.

Background: sore throat as one of the common postoperative challenges, with a prevalence of 65%, mandates more attention. Many therapeutic approaches have been tested; including ketamine gargle. This study compares the effect dexmedetomidine versus ketamine, both used as preoperative gargle, on the incidence and severity of postoperative sore throat in emergency surgical procedures. Materials and Methods: All patients undergoing emergency surgical procedures who referred to Shohadaye-Tajrish Hospital and needed anesthesia using succinylcholine for rapid sequence induction were considered as the target population and patients with ASA class 1-2, who aged 18-64 years, were enrolled. Inside the operating theatre, patients’ vital signs recorded and they were divided into ketamine and dexmedetomidine groups, each including 20 patients, receiving 0.5 mg/kg ketamine or 0.25µg/kg dexmedetomidine in 100cc water to gargle before induction of anesthesia. Standard similar anesthesia protocols were applied for all patients. In PACU sore throat was assessed using a visual analog scale (VAS) scoring. Results: in the ketamine group, 8 cases and in the dexmedetomidine group, 12 had dry throat (p= 0.150). The mean severity of the postoperative sore throat was 2.10± (minimum score of one and a maximum of 3) without significant difference between the two groups (p=0.344). mean diastolic pressure and SpO2 were significantly lower in the dexmedetomidine group compared with the ketamine group (p=0.047 and 0.001). Conclusion: both dexmedetomidine and ketamine gargle could be equally useful and effective in reducing postoperative sore throat.

Background: Tetralogy of Fallot (TF) in some Iranian patients is different in that the mitral z-value is significantly lower than normal. The present study was conducted to investigate the effect of the mitral Z-value on post-surgery mortality. Materials and Methods: The present retrospective analytical study was conducted on surgery candidate patients diagnosed with TF who had attended Shahid Modarres Hospital in Tehran between late March 2012 and late March 2019. Once the type of treatment and the need for surgery were decided and the mitral size and Z-value were determined, the patients underwent surgery, and then divided into two groups based on the outcome (death or discharge). Results: A total of 160 patients entered the study over seven years, of whom, 110 were discharged (group 1) and 50 died (group 2). There were no significant differences between the two groups in terms of gender. The patients' mean age was 8.96±8.09 years in the group 1 and 3.16±2.7 years in the group 2 (P<0.000). Mean mitral Z-value was -2.26±2.11 in the group 1 (ranging from -7.1 to +1.3) and -3.48±1.71 in the group 2 (ranging from -6 to -1.1), and Independent Sample Test showed no significant difference between the two groups (P=0.271). Conclusion: The mitral Z-value was significantly lower than normal in participating patients with TF, which could indicate hypo-plasticity of the left ventricle in Iranian patients with TF. No significant difference was found between the two groups in terms of surgical complications. In other words, the mitral Z-value had no effect on mortality of patients with TF.

In late 2019, a novel coronavirus, now designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China. Mortality rate, case fatality rate, and Years of Potential Life Lost can be measured by determining death cases. Much of our information on mortality rates of diseases can be obtained through a regular implementation of care plans that are often developed to screen infectious diseases. In the YLL component, the higher the individuals die at an earlier age, the longer their life is lost. For COVID-19, this component refers to the simple subtraction of age at death due to COVID-19 from the standardized life expectancy for the same age in the same sex. A potential application of health summary indices is to consider the non-fatal consequences of diseases to ensure that they are taken into account in health policy making. Given that COVID-19 has a non-fatal effect on a large number of patients, the estimation of disease burden using the DALYs may be an appropriate index for achieving this goal.

The coronavirus disease 2019 (COVID-19) was first detected in December 2019 in Wuhan, China . So far, 136 reports from the WHO were reported. In the latest report, 6416828 patients in almost all countries have been infected with the COVID-19. The present study discusses the different aspects of COVID such as emergence, signs and symptoms, comparisons with SARS and MERS, concerns, governments' actions in controlling the virus and a descriptive analysis of the spread and death. The emergence of the coronavirus family in the last two decades has created a public health issue around the world. It has also caused serious damages to infrastructure, economy, culture and communities of countries. Thus, affected governments have taken steps to reduce these concerns such as quarantine, education, traffic control, closure of recreational centers, reduction of working hours etc. Despite strict measures to contain the COVID-19, this virus is still expanding and the question of "what actions should be taken with what political package?" is being asked. To answer this question, it is important to understand the process of disease occurrence and modeling different interventions on changing the natural course of the disease is very important

Tourette’s syndrome (TS) is a neuro-behavioral disease associated by phonic and motor tics with a high frequency of psychiatric co-morbidities. For these cases, deep brain stimulation (DBS) is a developing neuro-modulated treatment option since the first report on a successful surgery in 1999. A male thirty-one years old (77 kg, 178 cm) with diagnosis of Gilles De La Tourette syndrome admitted to neurosurgery ward. His medication included Aripiprazole, pimozide, buspirone, clomipramine, citalopram, phenytoin, Desmopressin and Lithium. The patient underwent implanting DBS (Deep Brain Stimulator) surgery and battery implantation in two steps with two weeks interval. General anesthesia with considerations and according to behavior of disease and drug interactions was performed. The cause and symptoms may be due to central dopaminergic hyperactivity or anomalous dopamine neurotransmission and interventions and anesthesia should be done considering these abnormalities.

SARS-CoV-2 (COVID-19) is an infectious disease caused by a new discovered Coronavirus. Most people infected with the COVID-19 virus recover without special treatment and experience mild to moderate respiratory disease. In the elderly and people with underlying diseases such as cardiovascular disease, diabetes, chronic respiratory disease and cancer, there is a higher risk of developing the severe form of the disease. So far, no specific drug has been found to prevent or treat COVID-19. A 52-years old diabetic man with COVID-19 was admitted to Ayatollah Rouhani Hospital Babol, Iran. After 12 days of hospitalization and treatment, with respiratory distress and oxygen saturation level to 60%, he was transferred to the intensive care unit. After receiving a 400 mg dose of actemra or tocilizumab, the patient became severely dehydrated and the oxygen saturation level reached over 90% within a few hours, and 8 days after receiving tocilizumzb (TCZ; Actemra), the patient was suffering from complications of pneumonia. So far, there have been reports of improvement in patients with Coronavirus (COVID-19) with severe actemra or tocilizumab. Typically the COVID-19 virus appears to be able to be cause the over-immune reaction and typically the cytokine storm, which often includes IL-6, therefor may be IL-6 antagonist improves patients’s condition.

Following the outbreak of COVID-19 since December 2019 many reports have been published to conclude different presentations of this new infection. This report contains a summary of a young patient with a history of methadone intake, which experienced a cardiopulmonary arrest while he was preparing to take a lung Computerized Tomography (CT) scan in an outpatient setting. After a successful Cardio-Pulmonary Recovery in the CT scan room he was admitted in Intensive Care Unit. He had a prolonged QTc interval in Electrocardiograph and bilateral pulmonary involvement in Chest X-Ray.

Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guidelines and safety principles. Evacuated air from the exhaust reservoir and oxygenator, after close contact with the patient’s blood added contaminated secretions, drain into the operating room, a potential source for contamination. There are two air exhaust ways from the oxygenator in cardiopulmonary bypass (CPB) circuit; which might be the potential carrier of the Covid-19 virus and resulting contamination. In the current design, these two exhausts are connected to one antibacterial and antiviral filter and then they will attach to the ventilator's exhaust port with a three-way connector, in such a way that the contaminated air will be vented outside the operating room. It is recommended to use antibacterial and antiviral filters in the passage way of the contaminated air coming from Reservoir and Oxygenator exhaust, to be directly guided outside the operating room. In this article, this design is fully described.