Journal of Cellular & Molecular Anesthesia

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder of the central nervous system (CNS). Several studies indicated abnormal cell death in neurodegenerative diseases. Chalcone is a compound of natural origin with various properties such as antioxidant, anti-inflammatory, and inhibition of apoptosis. We investigated the impact of chalcone in an in-vitro model of PD.
Materials and Methods: PC12 cells were divided into four groups. Negative control, 6-hydroxy dopamine (6-OHDA) group (treatment with 75µM 6-OHDA), sham (treated with dimethyl sulfoxide), and the experimental groups with different dosages of chalcone treatment. Cell viability and reactive oxygen species (ROS) were assessed by MTT and ROS kit, respectively. The expressions of D2-like receptors, P53, and caspase III were evaluated by Western blotting.
Results: We found that 6-OHDA induced cytotoxicity and ROS production. The viability results showed that all doses of chalcone significantly increased viability after 48 hours compared to the control group (P<0.01). The western blotting results showed that caspase III and P53 expression decreased significantly in the experimental groups compared to the 6-OHDA group. However, D2-like receptor expression did not significantly differ between the experimental and the 6-OHDA group.
Conclusion: Complementary therapies, such as the use of antioxidants and the chalcone family, along with standard treatments for neurodegenerative diseases such as Parkinson's, may reduce the symptoms of the disease.

Background: Postoperative emergence delirium (ED) is common in pediatric patients anesthetized with sevoflurane. ED carries many complications, such as disorientation and perceptual changes, including motor hyperactivity and hypersensitivity to stimuli. ED usually appears in the early 30 min after awakening from general anesthesia. We assessed the effect of caudal dexmedetomidine versus midazolam added to bupivacaine in reducing the incidence and severity of ED.
Materials and Methods: Seventy-five children of either sex underwent lower abdominal or perineal surgeries. Patients were divided into three equal groups; BD (received caudal bupivacaine dexmedetomidine), BM (received caudal bupivacaine midazolam), and B(received caudal bupivacaine only). All patients were monitored intra and post-operatively regarding their hemodynamics. The post-operative pediatric anesthesia emergence delirium scale (PAED) and the post-operative face, legs, activity, cry, and controllability (FLACC) pain scale was used to assess ED and pain.
Results: Regarding the ED, group BD showed the least PAED score, followed by BM and then the B group, with the statistically significant difference found at 0 and 15 min in PACU (P<0.05). Assessment of the FLACC score and time of emergence revealed no statistically significant difference. At the same time, the number of patients who received IV dexmedetomidine and PACU stay was significant in group B (P<0.05). The intra-operative hemodynamics (NIBP, HR) showed no statistically significant difference between the three groups. In contrast, post-operative systolic blood pressure and heart rate showed a statistically significant difference at 0 and 15 minutes with higher values in group B, BM then the lowest values were recorded in group BD (P<0.05). Regarding the peri-operative complications, no patients experienced hypotension or bradycardia in the three groups.
Conclusion: Caudal dexmedetomidine and caudal midazolam are safe and efficient in decreasing the incidence and severity of ED. Furthermore, dexmedetomidine was more efficient, with the least PAED score. Dexmedetomidine is recommended to be used as an adjuvant to bupivacaine in the pediatric caudal block.

Background: Subarachnoid block (SAB) using isobaric ropivacaine provides rapid and reliable anesthesia with good muscle relaxation for lower limb surgeries. Fentanyl and dexmedetomidine are used as adjuvants to prolong intraoperative and postoperative analgesia. This study was done to compare their efficacy as an adjuvant to intrathecal ropivacaine for surgeries of fracture neck femur, as no such study has been done previously.
Materials and Methods: In this randomized, double-blind comparative study, 74 patients undergoing surgery for a fracture neck femur under SAB were randomly distributed into two groups. Group RD received 2.5 ml isobaric ropivacaine 0.75% (18.75 mg) with five µg of dexmedetomidine in 0.5 ml NS, and group RF received 2.5 ml isobaric ropivacaine 0.75% (18.75 mg) with 25µg Fentanyl (0.5ml) intrathecally. Block characteristics, hemodynamic changes, and other side effects were compared. Statistical analysis was done using SPSS Version 21.0 statistical analysis software.
Results: Time to onset of sensory block was earlier in group RD than in group RF (5.27±0.77 vs. 6.27±0.87 min). The total duration of sensory block, motor recovery by one level, complete motor recovery, and duration of motor block were significantly higher in the dexmedetomidine group. The mean rescue analgesic requirement was significantly higher in group RF than in group RD. In contrast, the time to first rescue analgesia was significantly later in group RD (292±16.75 vs. 190.41±12.93 min).
Conclusion: Dexmedetomidine produces earlier onset of sensory block, prolonged duration of sensory and motor blocks, and prolonged postoperative analgesia as compared to fentanyl when added as an adjuvant to ropivacaine for SAB.

Background: Obese parturients are at higher risk for epidural analgesic failure, so the dural puncture epidural (DPE) technique may have a particular advantage in this population. DPE has been suggested to improve the efficacy of labor epidural analgesia, potentially by facilitating the translocation of medication from the epidural to the intrathecal space. We designed this prospective interventional study to explore the influence of obesity on DPE technique regarding labor analgesia onset and quality.
Materials and Methods: The study was prospective interventional. A total of 64 parturients consented to receive DPE labor analgesia. Parturients were assigned according to pregestational body mass index groups into normal weight and obese groups. After the successful placement of the epidural catheter and puncturing of the dura, an analgesic regimen was initiated. The primary outcome was the median time to onset of sensory block assessed by Kaplan-Meier analysis.
Results: We found the median time to onset of sensory block to be 6 min in obese parturients compared with 13 min in nonobese. The difference between both groups was statistically significant (Chi-squared = 56.663, df = 1, P < 0.0001). Incidence rate ratio (95% CI) = 21.0 (9.51, 46.5). No asymmetrical block was noticed in both group, but a higher incidence of perineal dose supplementation and postoperative nausea were observed in the obese group.
Conclusion: DPE offers a favorable risk-benefit ratio for the management of neuraxial analgesia in obese parturients. Further studies comparing different volumes, concentrations, and methods of application of DPE local anesthetic are needed.

Background: Limited research has been conducted on the role of ultrasound in predicting difficult laryngoscopy (DL). This study aimed to evaluate the predictive values of upper airway ultrasound parameters for the degree of DL during intubation.
Materials and Methods: This observational-prospective study was performed on 120 patients requiring intubation during elective surgery. Initially, the degree of DL was assessed by the Mallampati Scale. The patient's neck circumference was then measured and recorded. Ultrasound was used to determine the hyomental distance in the neutral position (HMDN), the head extension (HMDE), as well as tongue width (TW), tongue thickness (TT), oral cavity height ratio (OCH), the amount of soft tissue (ST), and the Tongue thickness-to-oral cavity height ratio (TT/OCH). Afterward, the patients underwent general anesthesia and were intubated. The degree of difficult intubation was measured based on the Cormack-Lehane classification system. The patients were divided into easy and difficult laryngoscopy groups. Finally, the effectiveness of the two methods of ultrasound and intubation was compared.
Results: The Cormack score and Mallampati class recorded intubation difficulty as 28.3% and 30.8%, respectively. According to the Cormack score, only the neck circumference was significantly associated with intubation difficulty (P=0.002). Regarding Mallampati class, the neck circumference and HMDN, HMDE, TT, OCH, and ST were significantly associated with DL (P <0.05). The numerical value of the area under the curve (AUC) in the receiver operating characteristic (ROC) curve for sonographic parameters based on the Cormack score and Mallampati scoring system was poor (AUC <0.7).
Conclusion: The results showed that the accuracy of ultrasound criteria in predicting the severity of intubation with laryngoscopy is poor.

Background: to compare intravenous infusion of ketamine-propofol and ketamine-dexmedetomidine for deep sedation and analgesia in pediatric patients.
Materials and Methods: A total of 60 children aged 3-12 were divided into two groups, to receive drug dosage of Ketamine 2mg/kg and propofol 2 mg/kg IV. In group KP (Ketamine + Propofol) and 2mg/kg ketamine injection; also 1µg/kg dexmedetomidine for group KD (Ketamine + dexmedetomidine). In both groups, hemodynamic changes (MAP, Heart rate, and SpO2), pain, and sedation were assessed intraoperatively at 5, 10, 15, 20, and 30 minutes and post-operatively at 5, 10, 15, 30, and 60 minutes up to 6 hours. Both groups were similar in age distribution and weight from 9-30 Kg.
Results: Preoperative heart rate, mean arterial pressure, and SpO2 were statistically insignificant (P>0.05). MAP levels intraoperatively and postoperatively were higher in the KP group. Heart rates were lower in the KD group. Postoperatively pain scores were less in the KD group. Intraoperatively, sedation scores were similar in both groups.
Conclusion: the ketamine-propofol group had stable intra and post-operative hemodynamic parameters and early recovery scores.

Background: This study aimed to evaluate the neuroprotective effect of thiopental and its effect on serum NSE levels in neurocritical care patients.
Materials and Methods: Patients were divided into two groups (intervention and control). Thiopental administration as the intervention was started at a dose of 3-6 mg/Kg every 30 minutes and continued until 0.3-3 mg/Kg/hour. Sedation with fentanyl and midazolam as control was also performed in 35 patients. After three days, thiopental was discontinued. On the fifth day, the desired indicators were compared between the two groups.
Results: On the third and fifth days, patients in the intervention group had a greater drop in serum NSE levels (P<0.05).
Conclusion: The use of thiopental in patients undergoing neurosurgery transferred to the ICU can significantly reduce the NSE of these patients.

Marinesco-Sjogren syndrome (MSS) is a rare autosomal recessive disorder with different clinical signs and symptoms. Neurological dysfunction, especially in the cerebellum, ataxia, dysarthria, muscle atrophy, progressive hypotonia, skeletal deformity with scoliosis, mental retardation, and failure to thrive are common. Congenital cataracts and strabismus may need to be corrected via surgery. This disorder requires unique anesthetic consideration for myopathy, malignant hyperthermia, and respiratory depression. The neurodevelopmental delay also makes anesthetic management challenging in these patients. Muscle weakness and poor respiratory reserve in these patients may be associated with adverse effects if muscle relaxants are used during anesthesia. Case reports of anesthetic management of this syndrome are scarce. We report a child with MSS scheduled for lens removal surgery and anesthetic management.