Sleep deprivation: cardiovascular effects for anesthesiologists

Ali Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 45-46

Sleep and anesthesia have some common or "overlapping" neural pathways. Both involve wakefulness; while they are not the same; anesthesia is an iatrogenic, reversible, pharmacologic-based coma; which could affect the CNS neural pathways at many levels. In the current era of modern anesthesiology, the practice and science of anesthesia is composed of 4 basic elements; (1): 1. hypnosis (i.e. iatrogenic pharmacologicinduced coma) 2. amnesia (not to remember the events of the operation) 3. analgesia (being painless) 4. akinesia (lack of movements to stimuli) The first two ingredients of anesthesia could have common points with sleep. Thalamic nuclei are involved both in sleep and anesthesia (2, 3); though, they are not the same phenomena (4). However, could there be any clinical concern if some of our patients have abnormalities in sleep? In fact, the effects of sleep deprivation have long been studied in patients undergoing anesthesia for surgical operations (4, 5). Sleep deprivation causes altered neurohumoral activity, neuroendocrine dysregulations, abnormalities in the immune system and impairments in cardiac autonomic function (6, 7). Sleep deprivation may affect the clinical effects of the anesthetics or it may create unpredicted changes in the clinical response to a determined dose of anesthetic drugs (8). In this volume of the Journal, Choopani et al have published their results regarding sleep deprivation; they have demonstrated that in rats, if sleep deprivation is induced prior to an ischemia/reperfusion event, it can increase the chance for ventricular tachycardia and ventricular fibrillation; also, they have shown that this untoward effect could be eliminated using chemical sympathectomy (9). In clinical practice, the main message from this study could be that when anesthesiologists perform anesthesia for their patients, they should be aware of effects of acute or chronic sleep deprivation. Undoubtedly, sleep deprivation could occur during the perioperative period or maybe a longer accompanying abnormality in patients undergoing anesthesia for surgery. However, the unwanted cardiovascular effects are really of great importance. As Choopani et al have quoted the following are among the other unwanted effects of sleep deprivation which mandate our vigilance in these patients (9): • hypertension • over activity of the sympathetic nervous system • increased heart rate • vasoconstriction • salt retention Also, based on this study and other related studies (10-12), chemical sympathectomy could be an efficient method to relieve these effects. Preparedness against this phenomenon remains an important concern.

Original Articles

Effects of mesenchymal stem cells conditioned medium on behavioral aspects of inflammatory arthritic pain induced by CFA adjuvant

Vida Nazemian, Behzad Nasseri, Homa Manaheji, Jalal Zaringhalam

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 47-55

Background: Rheumatoid arthritis is a type of inflammatory pain and is an autoimmune and chronic inflammatory disease which can lead to hyperalgesia, edema and decreased motor activity in affected area. Mesenchymal stem cells conditioned medium (MSC-CM) has anti-inflammatory mediators which can regulate the immune responses, alleviate inflammatory symptoms and has a paracrine effects too. The aim of this study was to evaluate the effects of mesenchymal stem cells conditioned medium on behavioral aspects of inflammatory arthritic pain which induced by CFA adjuvant.

Materials and Methods: Complete Freund’s adjuvant (CFA)-induced arthritis (AA) was caused by single subcutaneous injection of CFA into the rats hind paw on day zero. MSC-CM was administered daily and intraperitoneal during the 21 days of the study after CFA injection. Hyperalgesia and edema were assessed on days 0, 7, 14 and 21 of the study respectively with radian heat and plethysmometer instrument.

Results: The results of this study indicated the significant roles of MSC-CM in betterment of inflammatory symptoms such as hyperalgesia and edema during different stages of inflammation caused by CFA. The continuing injection of MSC-CM could reduce the inflammatory symptoms.

Conclusion: Long term treatment by MSC-CM can alleviate hyperalgesia and edema and decrease those to the level of the time before induction of inflammation.



chronic sleep deprevation and ventricular arrhythmias: effect of symphatic nervous system

Samira Choopani, Alireza Imani, Mahdieh Faghihi, Sahar Askari, Zohreh Edalatyzadeh

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 56-61

Introduction: We assessed the effect of chronic sleep deprivation on incidence of ischemia/reperfusion-induced ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) and the role of the sympathetic nervous system in this respect.

Material and methods: Rats were randomly divided into four groups; 1) ischemia/reperfusion group (IR): 30 minutes ischemia followed by 60 minutes reperfusion was induced, 2) control group (CON): rats has been placed in large multiple platforms for 72h prior to ischemia and reperfusion, 3) Chronic sleep deprivation group( SD): 72h sleep deprivation was induced by using small  multiple platform prior to ischemia and reperfusion, 4) Sympathectomy group (SYM): chemical sympathectomy was done 24h before to chronic sleep deprivation and then underwent ischemia and reperfusion. The heart isolated and perfused by langendorff apparatus. After thoracotomy and aorta cannulation, the hearts perfused in the langendorff apparatus using krebs-Henseleit buffer. Hearts were allowed to recovery for 15 min. After recovery period, 15 minutes was considered as baseline prior to 30 minutes ischemia followed by 60 minutes reperfusion.Tow thin stainless stell electrodes fixed on the ventricular apex and right atrium for recording the lead II of electrocardiogram (ECG).

Results: There were no significant differences between heart rates between groups, and ventricular tachycardia significantly increased in chronic sleep deprivation group As compared with IR group in ischemia period. Sympathectomy significantly reduced ventricular tachycardia incidence when compared with SD. There is no difference in incidence of ventricular tachycardia between control group and IR group. The incidence of ventricular fibrillation during early reperfusion was significantly augmented (P<0.05) in sleep deprivation group as compared with IR group and Sympathectomy significantly could reverse ventricular fibrillation incidence to IR group level as compared with SD group (P<0.05).

Conclusion: Induction of 72 h sleep deprivation prior to ischemia and reperfusion increased the probability of ventricular tachycardia and ventricular fibrillation occurrence during ischemia and reperfusion and chemical sympathectomy could eliminate this effect.

Comparison the efficacy of pre-emptive oral celecoxib with acetaminophen in controlling post-operative pain and nausea after lower limb surgery under general anesthesia

Hamid Saryazdi, Omid Aghadavoudi, Daryoosh Moradi, Amir Hamedani

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 62-68


Up to now, there is no single opinion on how to control pain after surgeryand molecular and clinical research in this area has been continuing. This study aimed to compare the effect of premedication with oral administration of celecoxib and acetaminophen on postoperative pain relief in the lower extremity surgery under general anesthesia.


Materials and methods:

In a prospective, randomized, double-blinded, clinical trial study, 70 patients undergoing lower limb surgery under general anesthesia were distributed into two equal groups. In the first and second group, oral acetaminophen 1000 mg orcelecoxib 400 mg capsules were prescribed one hour before the operation, respectively. Postoperative painand nausea severity in both groups were evaluatedby VAS score and compared with each other.



Assessment of pain intensity at 1, 2, 6, 12 and 24 hours after surgery revealed that acetaminophen group at the first hour had more intensity of  postoperative pain (5.46±1.17) compared with celecoxib group(4.31±1.32)(P <0.001). In the rest of the time, there was no significant difference between the two groups. Analysis of variance with repeated observations showed, the trend of postoperative pain intensity during the study in both groups had a significant difference (p = 0.013). The intensity of nausea in the first hour after surgery was significantly more in acetaminophen group compared with celecoxib group (2.8±1.1 vs. 2.2±1.3, p<0.034).



Celecoxib may be a better choice in reducing pain and nausea after surgery compared with acetaminophen. Considering no significant adverse effects in many studies, celecoxib may be used as a pre-emptive medication to reduce pain after lower extremity surgery.

Key words: Premedication, Post-operative, PONV, pain, Celecoxib, Acetaminophen

Brief Communications

Identification of the First Iranian Family with “γArg275Cys” Mutation (Fibrinogen Tokyo II)

Gholamreza Toogeh, Maryam Helali, Shaban Alizadeh, Akbar Dorgalaleh

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 69-72

Background: Inherited fibrinogen deficiencies areclassified into two categories: quantitative, including afibrinogenemia and hypofibrinogenemia and qualitative, including dysfibrinogenemia. Any mutation in fibrinogen genes accounts for one of these disorders.

Case report: This article reports an Iranian family with dysfibrinogenemia without any clinical signs accidentally diagnosed by routine coagulation tests with slightly elevated PT and APTT a few years ago. Fordeterminationof disease causing genetic aberration in fibrinogen genes, DNA sequencing of three hot spots of these genes (i.e. exon 2 of FGA,exon 2 of FGB and exon 8 of FGG)was performed. Analysis of sequencing results revealed a heterozygous missense mutation c.901 C>T (Arg275Cys) in exon 8 of FGG in mother and children.No mutationwas detected in father’s sample.Fibrinogen with this mutation is known as Tokyo II.

Conclusion: γArg275Cys is a heterozygous mutation that impairs the function of fibrinogen andhas been solely reported in dysfibrinogenemic patients. Clinical findings in this family (no history of bleeding and thrombosis) were compatible with molecular results, because fibrinogen Tokyo II does not have a thrombotic or hemorrhagic nature and lack of clinical signs in this family is not unexpected.


Anesthetic consideration of Niemann-Pick Disease type C

Masoud Nashibi, Ardeshir Tajbakhsh, Farhad Safari, Kamran Mottaghi

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 73-77

Nieman-Pick disease type C is a rare, autosomal recessive, neurometabolic disorder associated with the accumulation of unesterified cholesterol in lysosomes and late endosomes. Because of multiple organ involvement and wide range of clinical manifestations, these patients will demand multiple diagnostic and therapeutic procedures requiring anesthesia. Sincepathogenesis of this disease is still unknown, further investigations on cellular and molecular basis of NPC is needed. In this report we present a known case of NPC1 requiring anesthesia for Percutaneous Endoscopic Gastrostomy and a brief review about molecular basis and recent advances in this field.




Opium abuse and its problems in anesthesia practice: a review from bench to bedside

Ali Dabbagh, Samira Rajaei

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 78-86

Opium is a derivative of opium poppy; the species of plant which its extract is used for preparing opium. Opium abuse is considered under drug dependency classification of psychiatric diseases and opium abusers have a number of major challenges before, during and after anesthesia for surgical operations (i.e. the perioperative period). This article reviews these clinical challenges during the perioperative period to discuss the new clinical findings for these patients and to demonstrate some of the main problems that physicians are encountered with.

Keywords: opium, abuse, anesthesia

Laboratory Diagnosis of Congenital Factor V Deficiency, Routine, Specific Coagulation Tests with Molecular Methods

Shadi Tabibian, Ahmad Kazemi, Akbar Dorgalaleh

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 87-90

Erratum: The correct affiliation of corresponding author of this manuscript has been edited as follows:

"Akbar Dorgalaleh: Department of Hematology and Blood Transfusion, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran."

Factor V (FV) deficiency is a rare bleeding disorder (RBD) that inherit in autosomal recessive manner. Diagnosis of FV deficiency (FVD) is made by routine coagulation tests, FV activity and molecular analysis. In patients with FVD, routine coagulation tests including activated partial thromboplastin time (APTT), prothrombin time (PT) and evenbleeding time (BT) are prolongedwhile thrombin time (TT) is normal. FV activity assay can use for confirmation of diagnosis as well as for differential diagnosis with acquired forms of disease. Mixing study can be used for screening of inhibitor against FV. In this situation, addition of normal plasma cannot correct prolonged PT and PTT while in congenital FVD prolongation is corrected. Molecular diagnosis of FVD is straightforward but due to large size of FV gene and genetic variability molecular diagnosis is restricted to research laboratory.

Dexmedetomidine Mechanism of Action: an update

Sara Salarian, Bahar Taherkhanchi, Ali Dabbagh, Mahboubeh Darban, Bahador Bagheri

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 2 (2016), 16 March 2016 , Page 91-94

Dexmedetomidine (PRECEDEX) is an imidazole derivative that is a highly selective a2 receptor agonist. Activation of the a2 adrenergic receptors by dexmedetomidine leads to both sedation and analgesia; with negligible respiratory and cardiovascular side effects. The drug is likely to be increasingly used for sedation and as an anesthetic adjunct.