Journal of Cellular & Molecular Anesthesia

Background: Insulin promotes the expression of genes related to brain function, thus preventing the neurodegeneration process. The present study was designed to find the neuroprotective effect of insulin by reducing neuron loss in the brain.
Materials and Methods: In this study, 20 adult male NMRI mice were divided into two groups: control and insulin. The control group was intact, and the insulin group received 100 µL of insulin at a 72-hour interval by intraperitoneal (I.P.) injection for 30 days. At the end of the study, the brain was removed. The volume of the brain and the total number of neurons and glia were estimated by stereological techniques, and also the gene expression of NSR, PI3K, AKT, IGF-1, and FOXO-1 was measured using real-time PCR.
Results: The results showed that the total number of neurons decreased in the control group compared to the experimental group. Furthermore, the expression of NSR, PI3K, AKT, IGF-1, and FOXO-1 genes was lower in the control group than in the insulin group.
Conclusion: The results showed that treating mice with insulin prevented reducing the number of neurons and gene expression related to normal brain function. So, insulin could have neuroprotective effects against neuron loss. Insulin may be beneficial as a new approach to avoiding neuron loss in regenerative medicine.

Background: Regional analgesia has an important role in the multimodal analgesia approach for postoperative pain management. Recently, the use of PVB is increased for providing effective analgesia. ESP block is a comparatively newer modality, established as a good analgesic technique. This study aimed to compare the postoperative analgesic efficacy of ultrasound-guided ESP block and PVB in thoracic surgeries.
Materials and Methods: This prospective randomized comparative open-label study involved 60 patients who underwent different thoracic surgeries and were randomized to receive ultrasound-guided ESP block (group A) or PVB (group B) with 20 ml 0.25% bupivacaine before induction of general anesthesia. Postoperatively, all patients received 1gm intravenous paracetamol injection every 8 hours. The primary outcome was to compare VAS scores at 0, 1, 3, 6, 12, and 24h, and secondary outcomes were assessed in terms of analgesic consumption and hemodynamic stability postoperatively
Results: Group A had a significantly lower VAS score at 0h, 1h, 3h, and 6h postoperatively (p=0.026, 0.003, 0.003, and 0.002, respectively) than group B. Thereafter, comparable VAS scores were found at 12 and 24h. However, the mean VAS in either of the group was <4 postoperatively. Rescue analgesic consumption was found comparable (p>0.05) in both groups. All patients exhibited stable hemodynamic profiles postoperatively.
Conclusion: Ultrasound-guided ESP block along with round-the-clock NSAIDs can be a better and safe alternative to PVB in thoracic surgeries with reduced analgesic consumption and hemodynamic stability.

Background: COVID-19 neurologic symptoms such as anosmia and ageusia are considered the most challenging issues for patients in the first steps of viral infection. Herein, we aimed to investigate the olfactory and gustatory dysfunction and their association with prognostic factors in patients with COVID-19.
Materials and Methods: The current retrospective study was performed on patients admitted to a hospital with a definite diagnosis of COVID-19 between March and November 2020. Based on the study criteria, information of 150 eligible participants (89 males and 61 females) was completely collected. The olfactory and gustatory symptoms including anosmia, hyposmia, ageusia, and dysgeusia were assessed, and five main COVID-19 prognostic factors including level of D-dimer, C-reactive protein (CRP), lymphocyte count (LC), lactic acid dehydrogenase (LDH) and COVID-19 related lung involvement were measured.
Results: Among all patients, 102 (68%) participants were completely treated and 48 (32%) died. Compared to treated patients, all prognostic factors including CRP, LDH, LC, D-dimer, and lung involvement were significantly higher in death cases. We found that 97 (64.7%) patients experienced at least one olfactory or gustatory dysfunction. The level of CRP, LC, D-dimer, and lung involvement showed a better prognosis among patients with at least one sensory dysfunction. Moreover, a better outcome was observed in patients with sensory dysfunction.
Conclusion: It can be concluded the evaluation of CRP, LDH, D-dimer, and LC together with the HRCT scan score contributes to a better prognosis in COVID-19 patients with sensory dysfunction.

Background: No trials were comparing the Bilateral Quadratus lumborum (QL) block versus transverses abdominis plane (TAP) block in patients undergoing laparoscopic hysterectomy. Hence the present study compared the ultrasound-guided bilateral TAP and QL blocks in patients undergoing total laparoscopic hysterectomy and measured the pain score, rescue anesthesia requirement, adverse events, and patient satisfaction.
Materials and Methods: This prospective randomized controlled open-labeled study was conducted on 140 adult female patients (ASA I-II) who were scheduled for total laparoscopic hysterectomy. Patients were randomized into two equal groups of 70 each (group TAP and group QL). Each patient received either Ultrasound-guided bilateral TAP or QL block after completion of laparoscopic hysterectomy under general anesthesia. Patients were monitored for Visual Analogue Scale (VAS) scores postoperatively, time for first analgesic requirement, and adverse effects if any. Independent t-test and Chi-square test were used for statistical analysis.
Results: Group QL showed significantly better VAS scores up to 24 hr postoperatively. VAS scores were significantly higher in group TAP than in group QL at all intervals postoperatively (p<0.05), the duration of postoperative analgesia was significantly shorter in group TAP than in group QL (p<0.05), and the total analgesic requirement was lesser in group QL than group TAP (p<0.05). Time for the first request for rescue analgesia was significantly longer in the group QL than in group TAP (497.774±35.45 vs 247.55±11.71min, p<0.001), and its consumption was significantly lesser in the group QL than in group TAP (72.1428±18.328 vs 138.57±25.77mg). The time for the first analgesic demand (Tramadol) was prolonged in group QL than in group TAP (15.1± 2.12 vs 4.35 ±5 hours). The sensory level was higher in the group QL than in the group TAP with a significant difference (7.92±0.51 vs 5.97±0.35, p<0.001). Three patients (4.28%) in the group QL experienced vomiting versus 6 (8.57%) in group TAP. Patient satisfaction score was comparable between group TAP and group QL (4.78 ± 0.45 vs 4.22 ± 0.42).
Conclusion: Bilateral QL block provided a better postoperative analgesia technique than bilateral TAP block in women undergoing laparoscopic hysterectomy.

Background: Red blood cell distribution width (RDW) is a vital marker associated with various clinical states. In the present study, we aimed to determine the associations between RDW changes and adverse effects caused by pediatric cardiac surgery.
Materials and Methods: In the present research, we retrospectively analyzed 100 pediatric patients enrolled in this study who were candidates for cardiac surgery. RDW was determined pre-and postoperatively and at the time of discharge from the hospital. Intubation time, duration of intensive care unit (ICU) stay and hospital stay, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, vasoactive inotropic score (VIS), and mortality rate were determined as well.
Results: Intubation time, duration of hospital stay, CPB time, ACC time, VIS, and mortality rate were significantly higher in the patients with higher RDW rates.
Conclusion: This study demonstrated that RDW could be used as an essential indicator in predicting both morbidity and mortality caused by pediatric congenital heart surgery.

Background: The incidence of preoperative anxiety is high. Anxiolytic agents have been used to reduce preoperative anxiety for many years. Recently the role of non-pharmacological interventions like preoperative information through interviews, counseling, and verbal reassurance for the reduction in preoperative anxiety has been established. But, the efficacy of these non-pharmacological interventions and the anxiolytic agent has not been compared previously. In this study, we compared the effectiveness of oral alprazolam and preoperative counseling by an anesthesiologist for the reduction of preoperative anxiety.
Materials and Methods: A total of 110 patients were randomly divided into two groups. Group A received 0.5 mg oral Alprazolam tablets, the night before surgery. Group C received counseling from an anesthesiologist with a fixed protocol the night before surgery. Anxiety was assessed with a state-trait anxiety inventory (STAI) scale, and scores were assessed in the pre-anesthetic assessment room, at night before surgery before giving study interventions, and on the day of surgery before shifting to the operation room. Hemodynamic parameters and respiratory rate were monitored along with anxiety scores. Data were analyzed using an independent t-test, Chi-square test, and repeated variance analysis measures (ANOVA).
Results: Anxiety scores and hemodynamic parameters were comparable between the groups at all times of measurement. Anxiety scores in the alprazolam group were less than counseling group on the day of surgery, but this difference was not statistically significant.
Conclusion: Although treatment with Alprazolam resulted in lesser anxiety scores, overall, both the methods were ineffective in reducing preoperative anxiety.

Background: Patients undergoing surgery may experience postoperative pain. The purpose of this study was to compare postoperative pain after cataract surgery with local anesthesia and general anesthesia performed at the Eye Hospital.
Materials and Methods: The study was a descriptive-analytic with a cross-sectional design, conducted at the Eye Hospital. There were 100 consecutive patients undergoing phacoemulsification procedures enrolled from September to November 2020. We assessed primary data using the Visual Analogue Scale (VAS) 24 hours after cataract surgery.
Results: The results were obtained based on the level of pain felt by the patient within 24 hours postoperatively. Of patients with general anesthesia, 34 people reported the most complaints, no pain in 30 people (88.2%), mild to moderate pain in four people (11.8%), and no complaints of severe pain. In 66 patients with local anesthesia, 35 people (53.0%) had no complaints of pain, 31 people (47.0%) had mild to moderate pain, and none complained of severe pain. By Chi-Square analysis, we found a significant difference between the type of anesthesia and postoperative pain (p<0.001).
Conclusion: The study found more patients without pain with general anesthesia than with local anesthesia in post-cataract surgery.

Wolfram syndrome is a rare progressive disease with diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD). Furthermore, other comorbidities and manifestations accompany this disease. Anesthetic management may be challenging in these cases and need special consideration due to present symptoms, disabilities, and comorbidities. This report presents anesthetic management of a traumatic patient with Wolfram syndrome candidate for orthopedic surgery. The report also discusses manifestation and anesthetic consideration in this population.

Patients with Grade III obesity pose unique challenges to the treating anesthesiologists. The challenges range from difficulty in intravenous cannulation to airway management. Regional anesthesia is advantageous over general anesthesia as it avoids airway manipulation, prevents reduction in functional residual capacity, and provides good postoperative analgesia. Regional anesthesia has its pitfalls like identifying the landmarks accurately and hemi diaphragmatic palsy following brachial plexus block. Hemi diaphragmatic palsy is poorly tolerated in grade III obese patients leading to increased peri-operative morbidity which undermines the advantages of regional over general anesthesia. Ultrasound-guided costoclavicular brachial plexus block(CCBPB) has the benefit of reduced hemi diaphragmatic palsy, avoiding pleural injury, and wider distribution of sensory blockade. Costoclavicular block has been administered to obese patients in the past with great success. We are reporting a successful case of ultrasound-guided costoclavicular brachial plexus block performed in an obese patient with a BMI of 51.56Kg/m².