Original Articles

Polymorphism of Gene OPRM A118G and COMT G158A and Pain Sensitivity of the Minangkabau Ethnic, Indonesia

Beni Indra, Nur Indrawaty Lipoeto, Djong Hon Tjong, Sukri Rahman

Journal of Cellular & Molecular Anesthesia, Vol. 8 No. 2 (2023), 26 Esfand 2023, Page 73-83

Background: Opioid is considered analgesic that has been used for thousands of years because of their effectiveness in treating pain during surgery. The opioid receptor encoded by the OPRM1 gene has several variants, including 118 A>G (adenine to guanine) that lead to different pain sensitivity. Other factors that also contribute to pain sensitivity are endogen opioids which are encoded by the COMT gene, which commonly has 168 G>A (guanine to adenine) polymorphism. This study aims to analyze the association between OPRM1 A118G and COMT G158A gene polymorphisms with pain sensitivity in the Minangkabau ethnic group.
Materials and Methods: This cross-sectional study took samples by consecutive sampling from 60 Minangkabau dan 30 non-Minangkabau patients that undergo general anesthesia in Dr. M Djamil Hospital and Andalas University Hospital, Padang, West Sumatra, Indonesia from early November 2021 until the end of January 2022. The association between OPRM1 A118G and COMT G158A gene polymorphisms with ethnicity and pain sensitivity was analyzed by Kruskal Wallis and Chi-square formulas respectively.
Results: We found there were no significant differences between OPRM1 A118G and COMT G158A gene polymorphisms in Minangkabau and non-Minangkabau ethnics (p=0.36 and p=0.53 respectively). The Difference between pain sensitivity before and after surgery in OPRM1 A118G and COMT G158 gene polymorphisms are not significant in Minangkabau ethnic (p>0.05).
Conclusion: OPRM1 A118G and COMT G158A gene polymorphisms had no significant association with pain sensitivity in Minangkabau ethnic.

Derangement of Basic Amino Acids and Nitric Oxide Levels in Patients Undergoing Cardiothoracic Surgery

Ahmed Farouk, Rasha Hamed, Nashwa Farouk Abd El Hafez, Rania Abdalla, Farag Moftah, Fify Alfy Gabra, Tahia Saleem

Journal of Cellular & Molecular Anesthesia, Vol. 8 No. 2 (2023), 26 Esfand 2023, Page 84-94

Background: A cyclic relationship exists, between; arginine, citrulline, and ornithine. Arginase is a specific enzyme that plays a role in this relationship. This study aimed to elucidate the role of surgical trauma and anesthesia on plasma levels of the previous acids and nitric oxide (NO) and to determine whether the changes in these levels can be correlated to the duration of surgery and anesthesia exposure.

Patients and methods: The study included: group A 41 patients who underwent coronary bypasses and group B 17 patients who underwent lung cancer surgery. The amino acid analyzer was used for the detection of amino acids, while NO was estimated by a Spectro-photometric method.

Results: The study revealed a significant decrease in the intra-operative levels of arginine, citrulline, ornithine, and NO compared to their pre-operative levels in both groups.

Conclusion: Depletion of these basic amino acids is possibly multifunctional and can be associated with an increase in arginase, surgical trauma, anesthesia, and stress.

Neuroapoptosis Signaling Pathways in Hippocampus Following Ovariectomy and Its Inhibition by Systemic Estradiol Replacement Therapy

Mana Jameie, Elahe Torabi, Maryam Golmohammadi, Saeed Vafaee-Nezhad, Mona Farhadi, Hojjat Allah Abbaszadeh, Seyed Behnamedin Jameie

Journal of Cellular & Molecular Anesthesia, Vol. 8 No. 2 (2023), 26 Esfand 2023, Page 95-104

In recent decades, there is a growing concern about neurodegenerative diseases (NDs) resulting from the increasing pattern of population age and life expectancy. Although there is no medical treatment for NDs, certain studies have suggested the neuroprotective role of estradiol (ES) in the brain. Hence hormone replacement therapy would be a promising therapeutic alternative for NDs. The present study was performed to investigate the beneficial effect of ES in the neurogenesis and neuro-apoptosis signaling pathways in the hippocampus following ovariectomy (OVX). Thirty Wistar rats were randomly assigned to 5 groups: 1) control 2) OVX, 3) OVX and ES, 4) Surgical sham, and 5) vehicle shams for ES. Eight weeks after surgery, OVX and ES group received an intramuscular injection of ES (20µg/rat) for 30 days, then hippocampi were obtained from all rats for molecular and histology studies. Nissl staining of the hippocampus for neuronal cell counting and western blot for detecting the expression of caspase-3 and cytochrome-c were performed. Based on our findings using western blot, overexpression of apoptotic proteins in the hippocampal tissue was observed in the OVX group. Furthermore, Nissl staining revealed a significant hippocampal neuronal cell death in the OVX group. In a nutshell, ES could result in the increase of neuron cells and the prevention of apoptosis in the hippocampus.

Spirulina for Protection Against COVID-19 via Regulating ACE2, FNDC5, and NLRP3: A Triple-Blind Randomized Placebo-Controlled Trial in Obese Adults

Fariba Armannia, Farshad Ghazalian, Mahdi Shadnoush, Hossein Keyvani, Mandana Gholami

Journal of Cellular & Molecular Anesthesia, Vol. 8 No. 2 (2023), 26 Esfand 2023,

Background: Spirulina may protect individuals against viral infections and promote health in obese subjects. This study is designed to investigate the impacts of spirulina on obesity to find a hope to protect this population against COVID-19.
Materials and Methods: In a double-blinded randomized placebo-controlled trial, 24 obese subjects (Mean age: 44.83±3.04 years; mean weight: 111.95±22.55kg; body mass index (BMI): 40.31±6.03kg/m2) were randomly allocated to spirulina (n=12) or control (Co, n=12) groups. Spirulina was administered 2 gr/day for 8 weeks and the Co group received a placebo for a similar period. Before and after the administration of spirulina, the anthropometric measurements were calculated for each subject. Furthermore, ACE2, NLRP3, and FNDC5 gene expression were examined in adults with obesity.
Results: Our findings demonstrated that spirulina could not effective in normalizing body weight (BW), BMI, and waist-hip ratio (WHR). Spirulina administration significantly upregulated the gene expression of FNDC5 and significantly reduced NLRP3 and ACE2 gene expression in obese subjects compared with the Co-group. Furthermore, by increasing FNDC5 the gene expression of NLRP3 and ACE2 was significantly reduced.
Conclusion: While administration of spirulina for eight weeks could not affect the anthropometric measurements, it showed the greatest impact on the gene expression of NLRP3, ACE2, and FNDC5, emplacing its potential in the protection of obese cases against COVID-19.

Apneic Oxygenation for Morbid Obese Parturient Undergoing Elective Cesarean Section Under General Anesthesia

Wael Abdelmoneim, Rania M. Ali

Journal of Cellular & Molecular Anesthesia, Vol. 8 No. 2 (2023), 26 Esfand 2023, Page 116-123

Background: Over the world, maternal obesity is a growing problem. Obesity and pregnancy make these parturients far more susceptible to fast desaturation during the apneic phase of anaesthesia. In this study, a morbidly obese pregnant woman undergoing an elective caesarean section under general anaesthesia will be preoxygenated either apneically or conventionally to compare the effects on oxygen desaturation.
Methods: One of two equal groups including sixty morbidly obese expectant women was chosen at random. In order to preoxygenate the body, 8 deep breaths of the vital capacity were taken for one minute at a rate of 15 L/min of 100% O2. In conjunction with the pre-oxygenation technique each patient either received 10 L/ min O2 via nasal prong (Group O) or not (Group C) according to the assigned group.
Results: When compared to Group C, Group O had a considerably lower lowest SpO2 during intubation and a lower occurrence of moderate hypoxemia. In addition, Group O experienced statistically considerably fewer problems than Group C, including arrhythmias and hypotension. However, the two groups' levels of foetal and neonatal health were comparable.
Conclusions: Nasal apneic oxygenation reduced the risk of hypoxemia and enhanced the lowest SpO2 in comparison to conventional preoxygenation. Accordingly, it may be considered as a practicable technique for preoxygenation of morbid obese parturient undergoing elective cesarean section under general anesthesia.

Brief Communications

Background: Postspinal shivering represents one of the distressing complications of regional anesthesia. This study evaluated the efficacy of dexamethasone and magnesium sulfate to prevent postspinal shivering (PSAS) in lower abdominal and lower limb surgeries.
Materials and Methods: Hundred forty-seven patients undergoing elective abdominal and lower limb surgery under spinal anesthesia received either 100 mL isotonic saline (group C), 8 mg in 100 mL isotonic saline (group D), or magnesium sulfate 30 mg/kg in 100 mL isotonic saline (Group M).
Results: The incidence of clinically significant shivering was highly significantly less in group D and group M compared to group C (p=0.001), however, there was no statistically significant difference between group D and group M (p=0.052). The onset of shivering was significantly lower in the C group compared to the D and M groups with statistically significant differences between the D and M groups (p=0.001).
Conclusion: Dexamethasone and magnesium sulfate were effective in the prevention of PSAS in patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. However, magnesium sulfate is better than dexamethasone as it is accompanied by less incidence of shivering, and its sedative effect decreases the stress of the surgery.

Background: Gastric ultrasound is considered a valuable tool for the assessment of gastric volume preoperatively.
Materials and Methods: The goal of this study was to assess the effect of granisetron on the gastric cross-sectional area by ultrasound estimation of its cross-sectional area for elective Cesarean Section. Sixty patients were assigned randomly into one of 2 groups; Granisetron group (n=30): received 1 mg granisetron diluted in 10 mL normal saline 0.9%. Control (n=30): received 10 mL of normal saline 0.9%. Cross-sectional area and volume of stomach contents were measured using ultrasound immediately before administration of the study drug and one hour later.
Results: No statistical difference was detected in post-treatment antral CSA nor gastric residual volume between the two groups (4.8±1.4 vs 4.6±2.1, P: 0.8) and (50±19 vs 57±27, P: 0.3) for antral CSA and gastric volume comparison between both groups. However, a significant statistical difference was found in antral CSA pre and post-granisetron administration (4.8±1.4 vs 4 ±1.2; P<0.001). The Granesitron group had a statistically significantly lower rate of nausea and vomiting than the control group.
Conclusion: Based on ultrasonographic measurement granesitron could effectively reduce the gastric cross-sectional area when administered preoperatively to parturients undergoing elective CS.

Case Report

Anesthetic Management of a 9-Years-Old Child Affected by Al-Raqad Syndrome Scheduled for Cataract Surgery: A Case Report

Azar Ejmalian, Nader Nassiri , Shahram Sayyadi, Dariush Abtahi, Elham Memari

Journal of Cellular & Molecular Anesthesia, Vol. 8 No. 2 (2023), 26 Esfand 2023, Page 135-138

Al-Raqad syndrome (ARS) is a novel and extremely rare autosomal recessive disorder. This syndrome affects many organs, mainly the central nervous and musculoskeletal systems. Al-Raqad syndrome’s manifestations include neurodevelopmental delays and a characteristic phenotype including craniofacial anomalies. This disorder, which is the result of a mutation in the Decapping Enzyme, Scavenger (DCPS) gene, was first described in 2015. We present a 9-year-old child affected with this syndrome, who suffers from severe neurodevelopmental delays, scheduled for cataract surgery. The anesthesia management focused on neurodevelopmental defects and craniofacial and musculoskeletal abnormalities. The reports of this syndrome are scarce, and to our knowledge, the present case is the first report of anesthesia management of this syndrome.