Original Articles

Preventive Effects of NSAIDs on Lung Tissue Oxidative Damage in an Animal Sepsis Model

Azadeh Rasooli, Mansoureh Abbasi, Zahra Shani, Reza Hajihosseini

Journal of Cellular & Molecular Anesthesia, Vol. 7 No. 1 (2022), , Page 2-8

Background/aim: Sepsis is a very heterogeneous syndrome that is caused by a dysregulated host response to infection. Inflammatory cascades have an important role in sepsis and can potentially be suppressed by anti-inflammatory compounds. So, this study was focused on the antiseptic effects of non-steroidal anti-inflammatory drugs (NSAIDs) on lung injuries based on cecal ligation and puncture (CLP) surgery.

Materials and methods: Male wistar rats divided into 6 groups (n=50) as follows: Control, Laparotomy (LAP), CLP and three treatment groups. The rats were killed after 48 h and the lung tissue was subjected to antioxidant enzymes (LP (lipid peroxidation), MPO (myeloperoxidase), and GSH (Glutathione)) and inflammatory genes expression (cyclooxygenase-2 (COX-2), CD177 and MPO).

Results: The results indicated that CLP caused lung injury by changes in antioxidant enzymes and genes expression (P<0.05). Treatments with indomethacin, celecoxib and aspirin as anti-inflammatory compounds significantly improved antioxidant enzymes by reducing LP and MPO level as well as genes expression and increasing level of GSH (P<0.05).

Conclusion: Our results indicated that sepsis caused oxidative damage in the lung tissue, and the uses of NSAIDs were effective in preventing and improving these injuries.

Background: Pain management in major abdominal surgery is an essential clinical task. Epidural analgesia alternatives have become popular; for instance, the quadratus lumborum (QL) block. Acute kidney injury (AKI) is one of the main complications encountered during major surgery. We aimed to assess the postoperative analgesic efficacy of the QL block compared to epidural analgesia as well as the effect on the postoperative kidney functions.
Materials and Methods: A total of 60 patients who underwent colorectal surgery with the American Society of Anesthesiologists (ASA) I–III were included and randomized into 2 groups; the study group received QL block (QL group), whereas the control group received epidural analgesia (EP group). Postoperative analgesia was assessed using a 10-point visual analog scale (VAS), time to first morphine requirement, and 24-hour morphine consumption. Postoperative renal function was compared with preoperative values using laboratory and renal Doppler indices.
Results: The age range was 35 to 65 years with 41 male patients, showing no significant difference between the two groups (P-value = 0.796 for age and 0.781 for sex). There was no significant difference between the QL block and the epidural analgesia regarding postoperative VAS pain score (P-value ranging from 0.066 to 0.869). The morphine analgesia parameters were statistically insignificant between the two groups. Nineteen patients required morphine among the QL group compared to 15 patients among the EP (P-value = 0.297), the mean cumulative dose was almost similar in both groups 3.1±1.2 mg (P-value = 0.973), and first-time use of morphine was 9.5±7.3 hours in the QL group compared to 5.9±6.0 hours in the EP group (P-value = 0.132). There was no significant difference between the 2 groups regarding blood urea nitrogen (BUN) and serum creatinine. However, QL showed significantly lower postoperative values in the renal resistive index (RI) than preoperative values. The mean RI value was 0.61±0.05 preoperatively compared to 0.58±0.05 postoperatively in the QL group (P-value = <0.001) compared to 0.62±0.05 preoperatively and 0.61±0.05 postoperatively in the EP group (P-value = 0.158).
Conclusion: QL block produced comparable analgesia with epidural anesthesia and was associated with improved postoperative renal artery flow, reflecting a better kidney performance; QL block may be the choice for patients with borderline kidney function or suspected AKI.

Background: The oxygen tension at half-saturation (P50) was found to be increased in patients with respiratory distress. However, the roles of P50 calculated upon hospital admission in predicting the prognosis of severe COVID-19 patients are not well-investigated. Thus, this study aimed to investigate whether P50 values obtained from hypoxic severe COVID-19 patients upon admission were associated with a later need of invasive mechanical ventilation (IMV). This study also aimed at finding independent predictors of IMV.

Methods: 151 patients with confirmed severe COVID-19 were enrolled in this study between August and December 2020. Overall, 63(41.7%) progressed to IMV, and 88(58.2%) did not need IMV. Demographic data, clinical outcome, and laboratory measurements were recorded and P50 was calculated. P50 that discriminated patients required IMV and patients did not require IMV was determined using the ROC curve. The risk factors for the need for IMV were identified through logistic regression.

Results: The calculated P50 of all patients was higher than the normal value (P<0.005). Moreover, P50 was significantly higher in patients who required IMV (P=0.002). ROC curve verified the discriminatory ability of P50, providing an area under the ROC curve of 0.647(95%CI 0.558-0.736; P=0.002) for a cut-off of 29.29mmHg. Calculated P50≥29.29mmHg was a risk factor for the need of IMV(OR=3.306, 95%CI 1.676-6.525; P=0.001). In multivariate analysis, the independent predictors of the need for IMV were older age, male sex, high P50, high aspartate transaminase, and low PO2 (P<0.05).

Conclusion: Calculated P50 on hospital admission might serve as a promising predictor of IMV in severe COVID-19.

Cystatin C and Neutrophil Gelatin-associated Lipocalin (NGAL) Can Predict Acute Kidney Injury and In-Hospital Mortality in COVID-19 Patients

Sanaa Wasfy, Eman Wasfey, Ashraf Elmaraghy, Eman AbdelFatah, Ayman Tharwat

Journal of Cellular & Molecular Anesthesia, Vol. 7 No. 1 (2022), , Page 32-39

Background: Prediction and early diagnosis of acute kidney injury (AKI) in critically ill Coronavirus disease 2019 (COVID-19) patients are of great importance. Therefore, using promising renal biomarkers such as cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) to identify the risk of future AKI is crucial.
Materials and Methods: A total of 89 adult patients with COVID-19 were included in this study. Serum cystatin C and NGAL concentration were assessed on intensive care unit (ICU) admission then repeated after 48 hours. Serum creatinine was followed for 7 days to report the development of AKI.
Results: Among the COVID-19 patients, 28.1% developed AKI. Although admission serum creatinine was not significantly different between the AKI group and the non-AKI group (p=0.375), admission Cystatin C (p=0.018), and NGAL (p<0.001) were significantly different between both groups. After 48 hours, a change in Cystatin C level (p<0.001) but not NGAL (p=0.4) was a predictor for AKI. Logistic regression model including age (p=0.031), Cystatin C on 48 hrs (p=0.003) and NGAL on admission (p=0.015) could predict AKI in COVID-19 patients.
Conclusion: Serum Cystatin C and NGAL in ICU could be used to predict AKI in COVID-19 patients. A logistic regression model including age, Cystatin C on 48hrs, and NGAL on admission might be a tool for individualized risk estimation of AKI in COVID-19 patients.

Uncovering Systemic Lupus Erythematosus Candidate Proteomic Biomarkers: A Bioinformatics Approach

Mona Zamanian Azodi, Mostafa Rezaei-Tavirani, Mohammad Rostami Nejad, Babak Arjmand, Mohhamadreza Razzaghi

Journal of Cellular & Molecular Anesthesia, Vol. 7 No. 1 (2022), , Page 40-48

Introduction: Molecular analysis of different types of disease could be helpful to understand the mechanisms of the related abnormal functions at that level of disorder. Lupus is not an exception, by the use of protein-protein interaction network analysis, it is possible to investigate the molecular basis and malfunctions in this kind of disease.

Materials and methods: Thirteen proteins were explored for interaction purposes and some 12 central proteins were obtained via Cytoscape analysis.

Results: Among these proteins, three proteins were from the differentially expressed proteins or in other words reported biomarkers of lupus. These proteins include Haptoglobin (Hp), Apolipoprotein C-III (APOC3), and Apolipoprotein A-I (APOA1).

Discussion: It can be concluded that the biological processes of the central proteins could be part of Lupus's underlying mechanisms. Finally, validation studies are proposed by this current evaluation of the introduced panel of hub biomarkers.

Brief Communications

Introduction: Supraglottic airway devices (SADs) offer an alternative airway with improved airway seal enable the use of higher airway pressures during positive pressure ventilation (PPV). We compared the safety and efficacy of laryngeal mask airway (LMA) Proseal and LMA Supreme in laparoscopic cholecystectomy.

Materials and Methods: Eighty patients, 18-60 years, ASA grade 1 & 2 were randomly allocated into two groups of 40 each. After induction of anesthesia, LMA Supreme or LMA Proseal of appropriate size was then inserted randomly. Parameters like the ease of LMA insertion; ease of OGT insertion; oropharyngeal leak pressure (OLP); hemodynamics; adequacy of ventilation were recorded. Complications, if any, were also recorded.

Results: LMA Supreme was easier to insert than LMA Proseal. Gastric tube insertion was comparatively easier in LMA Supreme than LMA Proseal. The mean oropharyngeal leak pressure was higher with LMA Proseal (31.98 ± 2.49cmH2O) than with LMA Supreme (30.23 ± 3.65 cmH2O). Peak airway pressures were comparable for the two groups. There was comparatively more airway trauma (mucosal injury, sore throat) in LMA Proseal than LMA Supreme.

Conclusion: A higher oropharyngeal leak pressure makes LMA Proseal a better choice than LMA Supreme in procedures with raised intragastric pressure.


Regenerative Medicine And Perioperative Hypoxic Organ Damage: Targeting Hypoxia-Inducible Factors

Soudeh Tabashi, Ardeshir Tajbakhsh , Mastaneh Dahi, Shideh Dabir, Maryam Vosoughian, Mohammadreza Moshari

Journal of Cellular & Molecular Anesthesia, Vol. 7 No. 1 (2022), , Page 58-65

Regenerative medicine is defined by utilizing body’s own repair mechanisms in order to restore normal function of tissues. An important perioperative cause of organ injury is hypoperfusion mostly due to hypoxia. Hypoxia can promote genomic pathway and increase the level of hypoxia-inducible factors (HIF). In this review we introduce HIF as a pioneer role of regenerative medicine for prevention of perioperative complications.

Case Report

COVID-19 in Myasthenia Gravis: The Double Whammy

Mohd Suhail Ashar, Kapil Dev Soni, Abhishek Singh, Yudhyavir Singh, Richa Aggarwal, Anjan Trikha

Journal of Cellular & Molecular Anesthesia, Vol. 7 No. 1 (2022), , Page 66-69

COVID-19 co-infection in patients with myasthenia gravis has not been well described.  Our primary aim is to describe the course of illness of a myasthenia patient who developed repeated episodes of myasthenic crisis along with severe COVID-19 infection.  This case highlights the need to accurately monitor the immune response to the infection and treatment of myasthenia gravis with COVID-19 should be tailored to the individual patient.

Anesthetic Management of Rapid Ventricular Response Atrial Fibrillation in an Elderly Woman Using Remifentanil; A Case Report

Fatemeh Roodneshin, Fereshte Kimia, Mahtab Poor Zamany Nejat Kermany

Journal of Cellular & Molecular Anesthesia, Vol. 7 No. 1 (2022), , Page 70-73

Atrial fibrillation (AF) is the most common cardiac Arrhythmia in all clinical settings. In the setting of atrial fibrillation with rapid ventricular response (AFib with RVR), early rate control (with or without restoration of the sinus rhythm) is the center of management. Several drugs are used for the management of rapid ventricular response AF but the optimal one is unknown yet. In this case report we present an elderly woman undergoing urgent ophthalmic surgery whose rapid ventricular response AF was controlled by Remifentanil.

Letter to the Editor