Journal of Cellular & Molecular Anesthesia

Background: Aortic clamping during abdominal aortic aneurysm repair surgery leads to complications such as systemic inflammatory response (SIRS) and dysfunction in various vital organs. This study aimed to investigate the effect of dexmedetomidine infusion on transcription factors and inflammatory cytokines during elective open abdominal aortic aneurysm repair surgery.

Materials and Methods: A prospective, clinical trial performed on patients with abdominal aortic aneurysm surgery, which were divided into two groups (dexmedetomidine, 8 patients and control, 12 patients). Demographic characteristics, biochemical laboratory variables, fluid and blood transfusions during surgery, and levels of inflammatory cytokines and expression of inflammatory genes were evaluated and compared in both groups.

Results: There were no significant differences between the two groups regarding demographic characteristics, biochemical laboratory variables, fluids, and blood transfusions during surgery (P> 0.05). The level of inflammatory cytokines and the expression of inflammatory genes in both groups decreased significantly after surgery (P <0.05). However, the level of inflammatory cytokines and the expression of inflammatory genes in the dexmedetomidine group were significantly lower at the end of the surgery (P <0.05).

Conclusion: In abdominal aortic aneurysm surgery, dexmedetomidine could significantly reduce complications of clamping during surgery, which may result in hemodynamic stability and prevent significant inflammatory response to surgical stress and organ damage following ischemia-reperfusion damage.

Background: Neurotoxicity effects of anesthetics in different age groups is a major concern regarding neural injuries. It is reasonable to recognize the neurotoxicity risks of anesthetic drugs and their combinations. Materials and Methods: A total of 16 mice (Mus musculus) weighing 22 to 30 gr were randomly divided into four drug groups (control, Ropivacaine, Ropivacaine + Dexmedetomidine, Ropivacaine + Dexamethasone). 24 hours after unilateral injection of drugs into the femoral nerve of mice, the mice were killed and their femoral nerve was removed. Hematoxylin-eosin tissue staining was used to evaluate changes in the effects of the drugs, and nerve samples were extracted to measure TLR4 and caspase 3 expressions. After Western blotting, the protein expression level was checked between different groups. Results: Ropivacaine in combination with dexamethasone caused less damage to the rat nerve cells. The combination of ropivacaine with dexamethasone (p=0.53 and p=0.46) compared to the combination of ropivacaine with dexmedetomidine relatively had better results in terms of cytotoxicity. Conclusion: A combination of ropivacaine with dexamethasone reduces neurotoxicity risk.

Background: Cardiac surgery especially in small children is associated with a marked decrease in thyroid hormone levels consistent with the phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of the present study was to determine if oral triiodothyronine could reduce the length of ICU stay, vasoactive inotropic score (VIS), and promote ejection fraction in infants and children undergoing cardiac surgery with CPB. Materials and Methods: In a double-blind clinical trial, one hundred and twenty children aged 6 to 60 months and scheduled for different types of cardiac surgery with CPB, were randomized into two groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5% dextrose water (placebo group), immediately after anesthesia and 24 hours after surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The intubation time, ICU stay length, ICU inotropic use, and cardiac ejection fraction was recorded. Results: The basic demographic data were comparable in two groups. No significant side effects or adverse reactions were seen due to hormone therapy. Intubation time, ICU stay, and VIS values were significantly shorter between the two groups. Conclusion: In children undergoing cardiac surgery with CPB, perioperative oral small-dose triiodothyronine therapy could improve clinical indices of perioperative care.

Background: Coagulation cascades are activated during Cardiopulmonary Bypass (CPB) and their proper monitoring and maintenance determine the outcomes of operation to a big extent. Here, we assessed serum fibrinogen and Fibrin Degradation Products (FDP) in adult patients undergoing CABG with using CPB, either with hypothermia or normothermia. Materials and Methods: In a cross-sectional study, 80 adult patients’ candidate for elective CABG were randomly assigned into two groups: hypothermia and normothermia to assess fibrinogen and FDP, perioperatively. Results: Patients included 32 men (80%) in the hypothermia group and 26 men (60%) in the normothermia with the mean age of 61.43 ± 12.64 years. The mean temperature in the hypothermia group was 32.33 ± 1.44 and 35.33 ± 0.71 in the normothermic group. Differences in fibrinogen levels between the two groups were not significant (Fib before CPB, P=0.893, and Fib after declamping, P=0.057). The serum level of FDP before and during CPB was not significantly different in hypothermia and normothermia groups (P=0.412, P=0.778, respectively). Conclusion: During cardiac surgery in hypothermia and normothermia conditions rate of fibrinogen decreased 25% after declamping in each group; this decrease seems to be due to hemodilution. FDP levels were similar in both groups.

Background: A wide range of approaches have been tested for the prevention and treatment of postoperative sore throat pain (POST pain). This study attempted to compare the effects of gargling with Ketamine or Magnesium Sulfate on POST pain.  Materials and Methods: In a randomized clinical trial, 60 patients scheduled for prone position laminectomy were randomly assigned into three groups: Ketamine (n=20), Magnesium (n=20), and Control (n=20). The Magnesium group received magnesium sulfate gargle (30 mg/kg in a total of 30 ml 5% Dextrose water), the Ketamine group received Ketamine gargle (0.5 mg/kg in a total of 30 ml 5% Dextrose water) and the control group received 30 ml 5% Dextrose water gargle; all these solutions were administered 10 min before anesthesia induction. Visual Analog Scale (VAS) for throat pain was recorded in the recovery room; immediately after arrival and then, at 2, 4, and 24 hours postoperatively in the ward. Would there be any VAS equal to or more than 3 of 10, rescue analgesics were administered immediately and their cumulative doses were recorded.  Results: The incidence of complaint-free patients in the Ketamine group was significantly higher than in the other two groups. The incidence of sore throat with VAS≥3, mandating rescue analgesia, was significantly lower than the other two groups. patient satisfaction after surgery was significantly higher in the Ketamine group.  Conclusion: Patients experiencing POST pain treated with “Ketamine gargle” had better results compared with “Magnesium Sulfate” or “Placebo” gargle. 

Background: hyperbaric bupivacaine is commonly used in regional anesthesia, especially for the subarachnoid blockade. Several studies demonstrated the efficacy of ropivacaine in different regional anesthesia techniques. Dexmedetomidine has been studied and shown to have synergism local anesthetics. In this study, we aimed to find the efficacy of dexmedetomidine in improving the analgesia quality and duration of the subarachnoid blockade in our hospital scenario. Materials and Methods: One hundred adult patients were divided into two groups of 50 each. Group A received 3 mL of 0.5% isobaric ropivacaine. Group B received 3 mL 0.5% isobaric ropivacaine was used for spinal anesthesia followed by a loading dose of IV dexmedetomidine. Group A received isotonic saline infusion. Results: The duration of the motor block in group A was 139.38±21.22 minutes vs.179.13±31.18 minutes in group B (P<0.05). Duration of the sensory block in group A was 156.79 ± 33.00 minutes vs. 208.13±48.32 minutes in group B (P<0.05), and the duration of the analgesia in group A was 168.69 ± 41.18 minutes vs. 278.57±34.65 minutes in group B (P<0.05). Conclusion: The use of IV dexmedetomidine improves analgesia quality and prolongs anesthesia duration in the subarachnoid block with 0.5% isobaric ropivacaine without any hemodynamic instability and with adequate sedation.

Background: This study aimed to evaluate the pain in the 24 hours after surgery, quality of life, and the outcome of surgery in patients undergoing urogenital surgery by spinal and general anesthesia. Materials and Methods: Women referring a candidate for urogenital surgery in Vali-e-Asr Hospital entered the study after their informed consent; in one of the two study groups: Spinal Anesthesia (SA) vs. General Anesthesia (GA). The pain scores around the clock were measured using the Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours postoperatively. Also, the two groups were compared regarding patient satisfaction at the time of ambulation. The surgery outcomes were measured using International Consultation on Incontinence Modular Questionnaires ICIQ. Data were entered and analyzed by SPSS software. Results: There was no significant relationship between parity, previous non-cesarean abdominal surgery, and urinary complications. However, there was a statistically significant difference between pain score in the two groups; while the postoperative days were not different in the two groups of anesthesia methods Conclusion: Considering the different influence of treatment methods for this disease, further research is needed to clarify, the results of anatomical, and anatomical outcomes after treatment for pelvic floor disorders in women.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has affected nearly 3.4 million people worldwide. People with comorbidities like chronic obstructive pulmonary disease, diabetes, hypertension, and coronary artery disease are at high risk of suffering from the most severe form of the disease. Various studies around the world have reported Obesity as one of the most common comorbidities associated with a high mortality rate. Noninvasive ventilation like continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) help in the perioperative management of these patients under normal circumstances but during COVID -19 pandemic they should be used with caution considering their aerosol generation potential. In this article, we will review the effect of morbid obesity and obstructive sleep apnea on perioperative outcomes and measures need to be taken that will benefit both patients as well as a healthcare provider.

Distal renal tubular acidosis (type 1 RTA) is associated with systemic non-anion gap metabolic acidosis. It is predominantly due to impaired hydrogen ion secretion and impaired bicarbonate reabsorption in the distal nephrons of the kidney. RTA is rarely encountered during pregnancy and is associated with potential risks for the mother and fetus due to alterations in maternal acid-base status and electrolytes. Anesthetic management aims to ensure the well-being of the mother and fetus. We report, the anesthetic management of a 28-year-old, full-term G4P0A3 (gravida 4, para 0 and abortions 3) female with distal renal tubular acidosis (type 1 RTA) with recurrent history of familial hypokalemic periodic paralysis in the background of ultrasonography detected morphological disorder of both the kidneys and hypothyroidism who was posted for emergency LSCS.

Venous air embolism (VAE) is an infrequent incident with fatal consequences during insertion or removal of central venous catheters. It is befalling when air or gas arrives at the vascular system. In this case report, we present a case of a 38-year-old female patient with an air embolism after removal of the Swan Ganz catheter that caused the seizure and cardiac arrest. There is an overview of the causes and ways to prevent VAE in the patient

The number of traumatic thoracic aortic injuries being treated by endovascular procedures is on the rise. Coronavirus (COVID-19) has affected healthcare systems worldwide and was declared a global pandemic by the world health organization (WHO) in March 2020. In this study, we discuss a 37-year-old man with thoracic aorta trauma caused by a motor–vehicle accident that underwent Thoracic endovascular aortic repair (TEVAR) and was incidentally diagnosed with concurrent COVID-19. During this pandemic period, physicians should be on the lookout for COVID-19 with low thresholds for testing, as a timely diagnosis will improve patient outcomes and reduce the risk of transmission. A delay in diagnosis puts the patients at risk of not receiving effective treatment and may result in the transmission of infection to hospital staff, environment (i.e. operating rooms and equipment), and other members of the community.

Today, due to the pandemic of novel coronavirus 2019 (COVID-19), extensive information over all parts of the world is spreading rapidly. We present seven cases of COVID-19 patients with pneumothorax as one of the ominous side effects of the disease and a strong predictor of death which is a new challenge in controlling the transmission and distribution of the disease.

In this article, we present a pregnant case suspected of COVID-19 with underlying symptoms of respiratory distress; which was referred to Shohada-e-Tajrish Hospital. Due to the progressive decrease of O2 saturation, the medical team decided to terminate the pregnancy to save the patient's life. Despite all these efforts including pharmaceutical agents, the patient passed away.