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Novikov, Andrei, Ekaterina Blinova, Elena Semeleva, et al. "On local anesthetic action of some dimethylacetamide compounds." Research Results in Pharmacology 4, no. 4 (2018): 1–8. http://dx.doi.org/10.3897/rrpharmacology.4.31440.
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The study aim was to explore local anesthetic properties of some tertiary and quaternary derivatives of dimethylacetamide. Materials and methods. The study was performed on white laboratory mice and rats of both sexes, male Agouti guinea pigs, and isolated sciatic nerves of lake frog. In the focus of the study there were two quaternary and eight tertiary compounds of dimethylacetamide with substituted anion with some amino and carbonic acids residue. A local anesthetic property was predicted by computational analysis. Acute toxicity of the most promising substances was studied in mice through subcutaneous route. Local anesthetic activity of tertiary compounds LKhT-3-00, LKhT-4-00 and quaternary LKhT-12-02 was studied on models of terminal, infiltration and conduction anesthesia. The influence of substances on mixed nerve conduction was investigated on lake frog’s isolated sciatic nerves. Results and discussion. The greatest probability of the local anesthetic activity during computational analysis was estimated for the tertiary derivatives of dimethylacetamide LKhT-3-00 and LKhT-4-00 and for the quaternary compound LKhT-12-02. According to their toxicological profile, the compounds belong to moderately toxic substances (class 3). On the model of terminal and infiltration anesthesia, substances LKhT-3-00 and LKhT-4-00 at concentrations of 0.5-1% rapidly cause deep and prolonged anesthesia. On the models of conduction anesthesia, the quaternary derivative of dimethylacetamide LKhT-12-02 has the greatest analgesic effect. The duration of the effect of the substance is over 3 hours. All the investigated compounds block sciatic nerve conduction. The longest effect is registered for LKhT-12-02. Conclusions. Dimethylacetamide derivatives at concentrations of 0.5-1.0% exhibit a local anesthetic activity, and are effective for terminal, conduction and infiltration anesthesia. Their effect is due to blockade of nerve conduction.
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Novikov, Andrei, Ekaterina Blinova, Elena Semeleva, et al. "On local anesthetic action of some dimethylacetamide compounds." Research Results in Pharmacology 4, no. (4) (2018): 1–8. https://doi.org/10.3897/rrpharmacology.4.31440.
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The study aim was to explore local anesthetic properties of some tertiary and quaternary derivatives of dimethylacetamide. Materials and methods. The study was performed on white laboratory mice and rats of both sexes, male Agouti guinea pigs, and isolated sciatic nerves of lake frog. In the focus of the study there were two quaternary and eight tertiary compounds of dimethylacetamide with substituted anion with some amino and carbonic acids residue. A local anesthetic property was predicted by computational analysis. Acute toxicity of the most promising substances was studied in mice through subcutaneous route. Local anesthetic activity of tertiary compounds LKhT-3-00, LKhT-4-00 and quaternary LKhT-12-02 was studied on models of terminal, infiltration and conduction anesthesia. The influence of substances on mixed nerve conduction was investigated on lake frog's isolated sciatic nerves. Results and discussion. The greatest probability of the local anesthetic activity during computational analysis was estimated for the tertiary derivatives of dimethylacetamide LKhT-3-00 and LKhT-4-00 and for the quaternary compound LKhT-12-02. According to their toxicological profile, the compounds belong to moderately toxic substances (class 3). On the model of terminal and infiltration anesthesia, substances LKhT-3-00 and LKhT-4-00 at concentrations of 0.5-1% rapidly cause deep and prolonged anesthesia. On the models of conduction anesthesia, the quaternary derivative of dimethylacetamide LKhT-12-02 has the greatest analgesic effect. The duration of the effect of the substance is over 3 hours. All the investigated compounds block sciatic nerve conduction. The longest effect is registered for LKhT-12-02. Conclusions. Dimethylacetamide derivatives at concentrations of 0.5-1.0% exhibit a local anesthetic activity, and are effective for terminal, conduction and infiltration anesthesia. Their effect is due to blockade of nerve conduction.
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Lester, G. D., J. R. Bolton, L. K. Cullen, and S. M. Thurgate. "Effects of general anesthesia on myoelectric activity of the intestine in horses." American Journal of Veterinary Research 53, no. 9 (1992): 1553–57. http://dx.doi.org/10.2460/ajvr.1992.53.09.1553.
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SUMMARY Myoelectric activity was monitored from the terminal ileum, cecum, and colonic pelvic flexure by use of Ag-pAgCl bipolar electrodes in 4 adult horses before, during, and after general anesthesia. Horses were anesthetized by way of 3 commonly used regimens, including xylazine (1.1 mg/kg of body weight) and ketamine hydrochloride (2.2 mg/kg); thiopental sodium (7.7 mg/kg), followed by halothane vaporized in oxygen; and thiopental sodium (2.5 g) in guaifenesin (100 mg/ml) solution given to effect, followed by halothane in oxygen. All 3 anesthetic regimens decreased intestinal spike-burst activity in the areas monitored. The slowest return to preanesthetic myoelectric activity was observed after xylazine and ketamine administration. After both of the barbiturate/halothane anesthetic regimens, there was a rebound increase in spike-burst frequency, without alteration in the proportion of propagative myoelectric events. All 3 anesthetic regimens appeared to reset the timing of the small and large intestinal migrating myoelectric complexes. By 9 hours after recovery from anesthesia, the effects of anesthesia, irrespective of regimen, had disappeared. Although anesthesia significantly (P < 0.05) altered intestinal myoelectric activity, no particular anesthetic regimen had a prolonged effect. Results of our study indicate that the particular chosen regimen of general anesthesia is unimportant in development of motility disturbances in horses after anesthesia.
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Desaulniers, Daniel, Al Yagminas, Ih Chu, and Jamie Nakai. "Effects of Anesthetics and Terminal Procedures on Biochemical and Hormonal Measurements in Polychlorinated Biphenyl Treated Rats." International Journal of Toxicology 30, no. 3 (2011): 334–47. http://dx.doi.org/10.1177/1091581810397774.
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This investigation reports the effects of various terminal procedures, and how they modified the responses to a toxicant (polychlorinated biphenyls [A1254], 130 mg/kg/day × 5 days) administered by gavage to Sprague-Dawley male rats. Terminal procedures included exsanguination via the abdominal aorta under anesthesia (isoflurane inhalation or Equithesin injection), decapitation with or without anesthesia, or narcosis induced by carbon dioxide inhalation. Effects of repeated anesthesia were also tested. Terminal procedures induced confounding stress responses, particularly when Equithesin was used. The terminal procedures modified the conclusions about effects of A1254 on the concentrations of corticosterone, insulin, glucagon, glucose, alkaline phosphatase, lactate dehydrogenase, uric acid, and blood urea nitrogen, from nonstatistically significant to significant changes, and in the case of luteinizing hormone from a statistically significant increase to a significant decrease. Investigations of effects of toxicants should be designed and interpreted considering potential changes induced by the selection of a terminal procedure.
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Kemelbekov, Ulan, Vitaly Volynkin, Symbat Zhumakova, Kulpan Orynbassarova, Marina Papezhuk та Valentina Yu. "Comparative Analysis of the Structure and Pharmacological Properties of Some Piperidines and Host–Guest Complexes of β-Cyclodextrin". Molecules 29, № 5 (2024): 1098. http://dx.doi.org/10.3390/molecules29051098.
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Pain and anesthesia are a problem for all physicians. Scientists from different countries are constantly searching for new anesthetic agents and methods of general anesthesia. In anesthesiology, the role and importance of local anesthesia always remain topical. In the present work, a comparative analysis of the results of pharmacological studies on models of the conduction and terminal anesthesia, as well as acute toxicity studies of the inclusion complex of 1-methyl-4-ethynyl-4-hydroxypiperidine (MEP) with β-cyclodextrin, was carried out. A virtual screening and comparative analysis of pharmacological activity were also performed on a number of the prepared piperidine derivatives and their host–guest complexes of β-cyclodextrin to identify the structure–activity relationship. Various programs were used to study biological activity in silico. For comparative analysis of chemical and pharmacological properties, data from previous works were used. For some piperidine derivatives, new dosage forms were prepared as beta-cyclodextrin host–guest complexes. Some compounds were recognized as promising local anesthetics. Pharmacological studies have shown that KFCD-7 is more active than reference drugs in terms of local anesthetic activity and acute toxicity but is less active than host–guest complexes, based on other piperidines. This fact is in good agreement with the predicted results of biological activity.
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Pollard, Richard J., Joseph P. Coyle, Richard L. Gilbert, and Janet E. Beck. "Intraoperative Awareness in a Regional Medical System." Anesthesiology 106, no. 2 (2007): 269–74. http://dx.doi.org/10.1097/00000542-200702000-00014.
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Background Intraoperative awareness in patients undergoing general anesthesia is an infrequent but well-described adverse outcome. The reported incidence of this phenomenon is between 0.1% and 0.9%. Methods With institutional review board approval, the authors reviewed continuous quality improvement data from 3 yr (2002-2004) at the locations where the physician group provided anesthesia. Board-certified anesthesiologists supervising certified registered nurse anesthetists in the anesthesia care team model of practice delivered all anesthetics. Brain function monitors were not used in the operating room setting. Patients were interviewed twice during a 48-h postoperative period and, as part of that process, underwent a modified Brice interview to determine intraoperative awareness. All cases that met the criteria for awareness were examined by the continuous quality improvement committee to modify anesthetic practice and were included in this study. Results Data from 211,842 patients undergoing anesthesia were considered. Of these, the continuous quality improvement process followed up 177,468 (83.1%). Cases were not included in the study if the patient was younger than 18 yr, did not have a general anesthetic, or had a terminal event during the hospital course. By these criteria, a total of 87,361 patients followed by the continuous quality improvement process were at risk for awareness. Six patients reported instances of recall. Conclusion The incidence of intraoperative awareness in this large sample of patients from a regional medical center undergoing general anesthesia was 0.0068%, or 1 per 14,560 patients, substantially less than that reported in the recent literature.
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Biddle, Chuck J., Beverly George-Gay, Praveen Prasanna, Emily M. Hill, Thomas C. Davis, and Brad Verhulst. "Assessing a Novel Method to Reduce Anesthesia Machine Contamination: A Prospective, Observational Trial." Canadian Journal of Infectious Diseases and Medical Microbiology 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/1905360.
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Background. Anesthesia machines are known reservoirs of bacterial species, potentially contributing to healthcare associated infections (HAIs). An inexpensive, disposable, nonpermeable, transparent anesthesia machine wrap (AMW) may reduce microbial contamination of the anesthesia machine. This study quantified the density and diversity of bacterial species found on anesthesia machines after terminal cleaning and between cases during actual anesthesia care to assess the impact of the AMW. We hypothesized reduced bioburden with the use of the AMW. Methods. In a prospective, experimental research design, the AMW was used in 11 surgical cases (intervention group) and not used in 11 control surgical cases. Cases were consecutively assigned to general surgical operating rooms. Seven frequently touched and difficult to disinfect “hot spots” were cultured on each machine preceding and following each case. The density and diversity of cultured colony forming units (CFUs) between the covered and uncovered machines were compared using Wilcoxon signed-rank test and Student’s t-tests. Results. There was a statistically significant reduction in CFU density and diversity when the AMW was employed. Conclusion. The protective effect of the AMW during regular anesthetic care provides a reliable and low-cost method to minimize the transmission of pathogens across patients and potentially reduces HAIs.
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Collins, John J., Holcombe E. Grier, Navil F. Sethna, Robert T. Wilder, and Charles B. Berde. "Regional anesthesia for pain associated with terminal pediatric malignancy." Pain 65, no. 1 (1996): 63–69. http://dx.doi.org/10.1016/0304-3959(95)00193-x.
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Ahonen, Jouni, Klaus T. Olkkola, Markku Salmenpera, Markku Hynynen, and Pertti J. Neuvonen. "Effect of Diltiazem on Midazolam and Alfentanil Disposition in Patients Undergoing Coronary Artery Bypass Grafting." Anesthesiology 85, no. 6 (1996): 1246–52. http://dx.doi.org/10.1097/00000542-199612000-00004.
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Background Midazolam and alfentanil are desirable anesthetic adjuncts for cardiac anesthesia. They are metabolized by cytochrome P450 3A (CYP3A) enzymes. These isozymes are inhibited by concurrent medications, including the calcium channel antagonist diltiazem, which may have an effect on recovery from anesthesia. Methods Thirty patients having coronary artery bypass grafting were randomly assigned to receive either diltiazem (60 mg orally 2 h before induction of anesthesia and an infusion of 0.1 mg.kg-1.h-1 started at induction and continued for 23 h) or placebo in a double-blind study. Anesthesia was induced with 0.1 mg/kg midazolam, 50 micrograms/kg alfentanil, and 20 to 80 mg propofol and maintained with infusions of 1 microgram.kg-1.min-1 of both midazolam and alfentanil supplemented with isoflurane. Plasma midazolam and alfentanil concentrations and areas under the plasma concentration-time curves were determined. The terminal half-life and the time for the drug plasma level to decrease 50% after cessation of the infusion (t50) were calculated for midazolam and alfentanil. Separation from mechanical ventilation and tracheal extubation were performed according to the study protocol. Results Diltiazem increased the mean concentration-time curves (from end of anesthesia until 23 h) of midazolam by 24% (P &lt; 0.05) and that of alfentanil by 40% (P &lt; 0.05). The mean half-life of midazolam was 43% (P &lt; 0.05) and that of alfentanil was 50% (P &lt; 0.05) longer in patients receiving diltiazem. The mean t50 of alfentanil was 40% longer (P &lt; 0.05) in patients receiving diltiazem, but the change in the mean t50 of midazolam (25%) was not statistically significant. In patients receiving diltiazem, tracheal extubation was performed on average 2.5 h later (P = 0.054) than in those receiving placebo. Conclusions Diltiazem slows elimination of midazolam and alfentanil and may delay tracheal extubation after large doses of these anesthetic adjuncts. CYP3A-mediated drug interactions should be considered as confounders when recovery from anesthesia with midazolam and alfentanil infusions is assessed.
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Bourgeois, Thomas, Maud Ringot, Nelina Ramanantsoa, et al. "Breathing under Anesthesia." Anesthesiology 130, no. 6 (2019): 995–1006. http://dx.doi.org/10.1097/aln.0000000000002675.
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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Optimal management of anesthesia-induced respiratory depression requires identification of the neural pathways that are most effective in maintaining breathing during anesthesia. Lesion studies point to the brainstem retrotrapezoid nucleus. We therefore examined the respiratory effects of common anesthetic/analgesic agents in mice with selective genetic loss of retrotrapezoid nucleus neurons (Phox2b27Alacki/+ mice, hereafter designated “mutants”). Methods All mice received intraperitoneal ketamine doses ranging from 100 mg/kg at postnatal day (P) 8 to 250 mg/kg at P60 to P62. Anesthesia effects in P8 and P14 to P16 mice were then analyzed by administering propofol (100 and 150 mg/kg at P8 and P14 to P16, respectively) and fentanyl at an anesthetic dose (1 mg/kg at P8 and P14 to P16). Results Most mutant mice died of respiratory arrest within 13 min of ketamine injection at P8 (12 of 13, 92% vs. 0 of 8, 0% wild type; Fisher exact test, P &lt; 0.001) and P14 to P16 (32 of 42, 76% vs. 0 of 59, 0% wild type; P &lt; 0.001). Cardiac activity continued after terminal apnea, and mortality was prevented by mechanical ventilation, supporting respiratory arrest as the cause of death in the mutants. Ketamine-induced mortality in mutants compared to wild types was confirmed at P29 to P31 (24 of 36, 67% vs. 9 of 45, 20%; P &lt; 0.001) and P60 to P62 (8 of 19, 42% vs. 0 of 12, 0%; P = 0.011). Anesthesia-induced mortality in mutants compared to wild types was also observed with propofol at P8 (7 of 7, 100% vs. 0 of 17,7/7, 100% vs. 0/17, 0%; P &lt; 0.001) and P14 to P16 (8 of 10, 80% vs. 0 of 10, 0%; P &lt; 0.001) and with fentanyl at P8 (15 of 16, 94% vs. 0 of 13, 0%; P &lt; 0.001) and P14 to P16 (5 of 7, 71% vs. 0 of 11, 0%; P = 0.002). Conclusions Ketamine, propofol, and fentanyl caused death by respiratory arrest in most mice with selective loss of retrotrapezoid nucleus neurons, in doses that were safe in their wild type littermates. The retrotrapezoid nucleus is critical to sustain breathing during deep anesthesia and may prove to be a pharmacologic target for this purpose.
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Faircloth, Amanda C. "Anesthesia Involvement in Palliative Care." Annual Review of Nursing Research 35, no. 1 (2017): 135–58. http://dx.doi.org/10.1891/0739-6686.35.135.
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Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery. More research is needed to further explore CRNA involvement in palliative care. However, CRNAs have a specialized knowledge of pharmacology and physiology that perfectly complements the multidisciplinary palliative care team.
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Datta, Sanjay, William Camann, Angela Bader, and Laura VanderBurgh. "Clinical Effects and Maternal and Fetal Plasma Concentrations of Epidural Ropivacaine Versus Bupivacaine for Cesarean Section." Anesthesiology 82, no. 6 (1995): 1346–52. http://dx.doi.org/10.1097/00000542-199506000-00004.
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Background Ropivacaine is a new amide local anesthetic structurally similar to bupivacaine and mepivacaine. Previous studies showed that ropivacaine has a similar clinical effect as bupivacaine with regard to sensory anesthesia and slightly less motor blockade than bupivacaine. Ropivacaine appears to be less cardiotoxic and arrhythmogenic than bupivacaine. The clinical and pharmacokinetic effects of 0.5% ropivacaine (5 mg/ml) versus 0.5% bupivacaine (5 mg/ml) when used epidurally for elective cesarean section were investigated. Methods Using a randomized, double-blind study design, 60 ASA physical status 1 or 2 term parturients presenting for elective cesarean section received either 0.5% bupivacaine (150 mg) or 0.5% ropivacaine (150 mg) epidurally in appropriate fractionated doses over a 10-min period. Onset, duration, and regression of sensory and motor blockade were noted until complete resolution was observed. Quality of intraoperative anesthesia and abdominal wall muscle relaxation were noted. Maternal plasma concentrations of local anesthetic were determined before anesthetic administration and 5, 10, 20, 30, and 60 min and 2, 3, 6, 8, 12, and 24 h after drug injection in 20 subjects. Umbilical cord blood was obtained at time of delivery for acid-base values and determination of the free and total plasma concentration of local anesthetic. Neonates also were examined for neurobehavioral assessments by Scanlon's and Neurologic and Adaptive Capacity Scores at 2 and 24 h after delivery. Results All patients received satisfactory anesthesia for operation. The onset, duration, and regression of sensory blockade were similar for both groups. Onset of degree 1 and 2 motor blockade was faster, and duration of degree 1 motor block was longer in the group receiving bupivacaine. Hemodynamic sequelae were similar between groups. All neonates had 5-min Apgar scores of 7 or greater and normal acid-base values and neurobehavioral assessments. Pharmacokinetic analysis showed that the Cmax was similar for both drugs (1.3 +/- 0.09 for ropivacaine and 1.1 +/- 0.09 micrograms/ml for bupivacaine). The T1/2 of the terminal decline in plasma concentration was shorter for ropivacaine versus bupivacaine (5.2 +/- 0.60 versus 10.9 +/- 1.08 h, respectively; P &lt; 0.01). The free (i.e., unbound) concentrations of ropivacaine were approximately twice those of bupivacaine in both maternal and neonatal blood at the time of delivery. The ratio of umbilical vein to maternal vein concentration of unbound drug was 0.72 for ropivacaine and 0.69 for bupivacaine. Conclusions Ropivacaine, 0.5%, epidurally provided satisfactory and similar sensory anesthesia compared to 0.5% bupivacaine for elective cesarean section. The Cmax was similar for both drugs, although the terminal half-life of ropivacaine was significantly shorter, and the blood concentrations of free ropivacaine were significantly greater than that for bupivacaine. These values were less than concentrations shown to be toxic in animals.
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LaTourette, Philip C., Emily M. David, Cholawat Pacharinsak, Katechan Jampachaisri, Jennifer C. Smith, and James O. Marx. "Effects of Standard and Sustained-release Buprenorphine on the Minimum Alveolar Concentration of Isoflurane in C57BL/6 Mice." Journal of the American Association for Laboratory Animal Science 59, no. 3 (2020): 298–304. http://dx.doi.org/10.30802/aalas-jaalas-19-000106.
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Both standard and sustained-release injectable formulations of buprenorphine (Bup and BupSR, respectively) are used as preemptive analgesics, potentially affecting gas anesthetic requirements. This study tested the effects of Bup and BupSR on isoflurane requirements and confirmed that buprenorphine could reduce isoflurane requirements during a laparotomy in mice. We hypothesized that both Bup and BupSR would significantly decrease the required minimum alveolar concentration (MAC) of isoflurane. C57BL/6 mice received either isotonic crystalloid fluid (control), Bup (0.1 mg/kg), or BupSR (1.2 mg/kg) subcutaneously 10 min prior to the induction of anesthesia. Each anesthetized mouse was tested at 2 isoflurane concentrations. A 300-g noxious stimulus was applied at each isoflurane concentration, alternating between hindfeet. In addition, a subset of mice underwent terminal laparotomy or 60 min of anesthesia after injection with Bup, BupSR, or saline to ensure an appropriate surgical plane of anesthesia. Mice were maintained at the lowest isoflurane concentration that resulted in 100% of mice at a surgical plane from the aforementioned MAC experiments (control, 2.0%; Bup and BupSR, 1.7%). Analysis showed that both Bup and BupSR significantly decreased isoflurane requirements by 25.5% and 14.4%, respectively. The isoflurane MAC for the control injection was 1.80% ± 0.09%; whereas Bup and BupSR decreased MAC to 1.34% ± 0.08% and 1.54% ± 0.09%, respectively. Sex was not a significantly different between the injection groups during MAC determination. All of the mice that underwent surgery achieved a surgical plane of anesthesia on the prescribed regimen and recovered normally after discontinuation of isoflurane. Lastly, heart and respiratory rates did not differ between mice that underwent surgery and those that were anesthetized only. Bup and BupSR are MAC-sparing in male and female C57BL/6 mice and can be used for effective multimodal anesthesia.
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Zinchenko, S. V., I. M. Fatkhutdinov, and D. А. Akhmadeeva. "HISTORY OF LOCAL ANESTHESIA." Oncology bulletin of the Volga region 13, no. 1 (2022): 76–81. http://dx.doi.org/10.32000/2078-1466-2022-1-76-81.
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The analgesic properties of coca leaves have been known to the Mayan tribes since the 2nd millennium BC. Local anesthesia begins its official history since the middle of the 19th century. In 1859, the German chemist Albert Neumann (1834 – 1861), who worked at the University of Göttingen, isolated a 0,25% alkaloid in its pure form, which he called «cocaine». The scientist noticed the numbness of the tongue that occurs after contact with cocaine. The art of local anesthesia is very dynamic, this is reflected both in the development of this direction at the present time and in its history. To date, the history of local anesthesia has more than 160 years. Over the specified period of time, local anesthesia has undergone major changes. Local anesthetics are a legacy that preserves the many years of work of scientists and doctors, their experience. With their help, millions of patients in the world every day get rid of pain during operations and various surgical interventions. This study uses general methodological approaches for historical and medical research, reflecting the dynamics of the development of local anesthesia in medicine, its role at the present stage of the development of medical science. Based on the data obtained, the following stages of the development of local anesthesia can be distinguished. It all started with terminal anesthesia, then there was a stage of infiltration anesthesia, which is still widely used today. At the beginning of the 20th century, doctors began to practice case anesthesia. This technique has expanded the possibilities of local anesthesia. The use of local anesthetics for regional anesthesia is the highest level of its application. Local anesthesia is currently at the next stage of its development. Today we have a wide variety of local anesthetics, and local anesthesia is increasingly being used in pediatric surgery. Understanding history allows us to expand the horizons of our knowledge.
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O’Brien, Caitlin E., Polan T. Santos, Ewa Kulikowicz, et al. "Hypoxia-Ischemia and Hypothermia Independently and Interactively Affect Neuronal Pathology in Neonatal Piglets with Short-Term Recovery." Developmental Neuroscience 41, no. 1-2 (2019): 17–33. http://dx.doi.org/10.1159/000496602.
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Therapeutic hypothermia is the standard of clinical care for moderate neonatal hypoxic-ischemic encephalopathy. We investigated the independent and interactive effects of hypoxia-ischemia (HI) and temperature on neuronal survival and injury in basal ganglia and cerebral cortex in neonatal piglets. Male piglets were randomized to receive HI injury or sham procedure followed by 29 h of normothermia, sustained hypothermia induced at 2 h, or hypothermia with rewarming during fentanyl-nitrous oxide anesthesia. Viable and injured neurons and apoptotic profiles were counted in the anterior putamen, posterior putamen, and motor cortex at 29 h after HI injury or sham procedure. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) identified genomic DNA fragmentation to confirm cell death. Though hypothermia after HI preserved viable neurons in the anterior and posterior putamen, hypothermia prevented neuronal injury in only the anterior putamen. Hypothermia initiated 2 h after injury did not protect against apoptotic cell death in either the putamen or motor cortex, and rewarming from hypothermia was associated with increased apoptosis in the motor cortex. In non-HI shams, sustained hypothermia during anesthesia was associated with neuronal injury and corresponding viable neuron loss in the anterior putamen and motor cortex. TUNEL confirmed increased neurodegeneration in the putamen of hypothermic shams. Anesthetized, normothermic shams did not show abnormal neuronal cytopathology in the putamen or motor cortex, thereby demonstrating minimal contribution of the anesthetic regimen to neuronal injury during normothermia. We conclude that the efficacy of hypothermic protection after HI is region specific and that hypothermia during anesthesia in the absence of HI may be associated with neuronal injury in the developing brain. Studies examining the potential interactions between hypothermia and anesthesia, as well as with longer durations of hypothermia, are needed.
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Ionov, S. N., M. V. Sharavina, and Yu S. Makhnycheva. "Malignant hyperthermia." Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH), no. 1 (January 11, 2022): 5–17. http://dx.doi.org/10.20340/vmi-rvz.2022.1.phys.1.
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Malignant hyperthermia manifests as hypermetabolism of striated voluntary muscle. Generally, this condition occurs during general anesthesia when inhalational anesthetics and succinylcholine are used. During the malignant hyperthermia attack, the oxygen consumption increases, lactate accumulates, the production of CO2 grows and excessive heat is generated. The crisis of malignant hyperthermia is a dangerous and potentially terminal complication of general anesthesia that requires rapid resolution in the shortest possible time. The only drug that can stop the acute state of malignant hyperthermia – dantrolen, is currently prohibited for import in Russia and is not legalized. Treatment of malignant hyperthermia is extremely difficult for all anesthesiologists in Russia and a great danger for patients with this condition.
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Zholkovsky, A. V., V. V. Ermolenko, T. S. Borondzhiyan, L. L. Timofeeva, V. E. Chubarov, and I. A. Urusov. "THE QUALITY OF LIFE IN PATIENTS WITH CORONARY HEART DISEASE." Journal of Clinical Practice 8, no. 1 (2017): 30–34. http://dx.doi.org/10.17816/clinpract8130-34.
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Occlusion of terminal aorta is mostly often caused by atherosclerosis and the development of lower limb ischemia requires prompt treatment. In addition to the open aortic surgery recanalization and stenting can also be used. The article presents the first experience of endovascular treatment in patients with good immediate and mid-term results. This method is suitable to use in patients with contraindications to general anesthesia.
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Menk P. Lima, Jose Cesar, and Fabio Del Piero. "Severe Concomitant Physaloptera sp., Dirofilaria immitis, Toxocara cati, Dipylidium caninum, Ancylostoma sp. and Taenia taeniaeformis Infection in a Cat." Pathogens 10, no. 2 (2021): 109. http://dx.doi.org/10.3390/pathogens10020109.
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Here we describe an unusual and severe mixed parasitic infection in a cat that died during routine surgery. Gastric Physaloptera sp., cardiac Dirofilaria immitis, and intestinal Toxocara cati, Dipylidium caninum, Ancylostoma sp. and Taenia taeniaeformis were observed. Histologic lesions included chronic proliferative pulmonary endarteritis, mild increase of mucosal intestinal white cells, and terminal aspiration of gastric content. The severe dirofilariasis may have contributed to this patient death during anesthesia.
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Jonathan, Almeida Moura, and Nayanne Fernandes de Araujo Karlla. "CUIDADOS PALIATIVOS: ASPECTOS GERAIS, CONTROLE DA DOR E O PAPEL DO ANESTESIOLOGISTA: UMA REVISÃO INTEGRATIVA DE LITERATURA." REVISTA FT 28, no. 128 (2023): 24. https://doi.org/10.5281/zenodo.10157624.
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Os Cuidados Paliativos surgem como uma filosofia humanitária de cuidar de pacientes em estado terminal, aliviando a sua dor e o sofrimento. Estes cuidados preveem a açãode uma equipe interdisciplinar, onde cada profissional reconhecendo o limite da sua atuação contribuirá para que o paciente, em estado terminal, tenha dignidade na sua morte. Especificamente no campo da anestesia, a expansão dos cuidados paliativos é ainda mais recente, verificando-se que os desafios para o anestesista que assiste o paciente que requer cuidados paliativos vêm aumentando devido ao crescente progresso obtido com as novas técnicas de analgesia e sedação. O cuidar em anestesia paliativa destina-se a prover conforto, proporcionar ao outro o seu próprio cuidado e dar-lhe o poder de se responsabilizar por isso. Dentre essas novas técnicas destaca-se aanalgesia controlada pelo paciente (ACP).
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Priambodo, Bhimo, and Bhirowo Yudo Pratomo. "Anesthetic Management for Abdominal Aortic Aneurysm Rupture." JAI (Jurnal Anestesiologi Indonesia) 16, no. 1 (2024): 127–37. http://dx.doi.org/10.14710/jai.v16i1.58325.
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Background: Aortic aneurysm is the thirteenth leading cause of death in the united states. Around 15.000 people died each year because of aortic aneurysm rupture. The mortality rate for this case are still high at around 90%. Patient diagnosed with acute aortic rupture will need an urgent surgery.Case: A 36-year-old man came with complaints of pain in the waist to back area since 1 week before entering the hospital and worsening 2 days before entering the hospital. Pain is felt intermittent. The pain is sharp and severe when the patient strains. On physical examination found high blood pressure (160/104 mmHg), chest X-ray showed widening of the mediastinum suspected descending aortic aneurysm, CT angiography showed a fusiform type descending aortic aneurysm pars thoracoles, ruptured abdominal aortic aneurysm of juxtarenal fusiform type to the terminal abdominal aorta and hemoperitoneum. The patient underwent repair of an abdominal aortic aneurysm under general anesthesia. After surgery the patient was admitted to the ICU for clinical and hemodynamic monitoring, but the patient's condition in the ICU worsened. The patient experienced acute kidney failure and liver failure, then the patient died on the 10th day after surgery.Discussion: Surgery for ruptured abdominal aortic aneurysm is associated with high mortality. Even patients who survive the initial procedure are at high risk of complications (such as renal, cardiac, respiratory, haematological, or gastrointestinal failure). The main goal of anesthesia is to maintain anesthesia with cardiovascular stability and normothermia for as long as possible. Minimum standards of monitoring for surgery include electrocardiogram, CVP, arterial line, temperature, and urine output. This operation uses a cell saver machine which functions to collect lost blood, clean the blood and return it to the patient.Conclusion: Surgery for patients with acute aortic rupture requires complicated and complex anesthetic techniques. This operation requires collaboration and good communication between the surgeon and the anesthesiologist.
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Oda, Kazunori, Takashi Morishita, Hideaki Tanaka, Hiromasa Kobayashi, and Hiroshi Abe. "Case report: Radiofrequency thalamotomy as palliative care for Holmes tremor in a patient with terminal cancer and cardiac pacemaker." Surgical Neurology International 13 (October 21, 2022): 484. http://dx.doi.org/10.25259/sni_618_2022.
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Background: Herein, we present a case report of a patient with Holmes tremor due to thalamic infarction with end-stage pancreatic cancer who underwent successful computed tomography (CT)-guided ventralis intermedius nucleus (Vim) thalamotomy as palliative care. Case Description: A 78-year-old man with gradually worsening involuntary movements on the left side of his body 2 years after a right thalamic infarction was referred to our institute. He had a history of chronic atrial fibrillation for which he was implanted with a cardiac pacemaker not compatible with magnetic resonance imaging. He also received adjuvant therapy for pancreatic cancer. As the involuntary movements interfered with his daily life, the patient elected for neurosurgical treatment despite having terminal cancer. Although the prognosis for pancreatic cancer was considered to be more than 6 months at the time of surgery, we performed CT-guided Vim thalamotomy under local anesthesia without pulse generator implantation considering the patient’s general condition. The involuntary movements of the left side of the body reduced following surgery, thus improving his quality of life (QOL). However, 6 months after thalamotomy, the patient died of pancreatic cancer. Conclusion: Thalamotomy significantly reduced the involuntary movements immediately after the procedure. Therefore, thalamotomy can be performed under local anesthesia without the use of any device and may contribute to the improvement of QOL in terminal patients.
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Kim, Gyun Moo, Chan Lee, and Tae Chang Jang. "Zoletil promotes apoptosis in BV-2 microglial cells via induction of oxidative stress and neural inflammation." Toxicology Research 11, no. 1 (2021): 134–46. http://dx.doi.org/10.1093/toxres/tfab115.
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Abstract Zoletil® (ZOL) is a combination drug of tiletamine, a dissociative anesthetic and zolazepam, a minor tranquilize, which has been used to induce short-term anesthesia in various animals. Depending on the administered dose, the effects of ZOL can range from sedation to anesthesia. Here, we aimed to determine the neurotoxicity of ZOL and elucidate its mechanism of action using BV-2 microglial cells. The results of MTT reduction assay and TUNEL staining revealed that ZOL induced neuronal toxicity and apoptosis in BV-2 cells. ZOL caused apoptosis via phosphorylation of c-Jun N-terminal kinase, increased ratio of Bax to Bcl-2, disruption of mitochondrial membrane potential, activation of caspase-3, and cleavage of poly (ADP-ribose) polymerase. Furthermore, reactive oxygen species were involved in ZOL-induced neuronal cell death as assessed by 2′,7′-dichlorofluorescein diacetate staining. Moreover, BV-2 cells treated with ZOL exhibited increased expression of inflammatory enzymes, such as inducible nitric oxide synthase and cyclooxygenase-2, along with subsequent production of nitric oxide and prostaglandin E2. ZOL upregulated the expression of interleukin-1β, a proinflammatory cytokine. With respect to its molecular mechanism, ZOL increased the nuclear translocation and DNA binding of redox-sensitive transcription factor NF-κB, which seemed to be mediated by activation of extracellular signal-regulated kinase and p38 mitogen-activated protein kinase. These findings suggest that ZOL leads to apoptosis in BV-2 cells by inducing oxidative stress and inflammatory responses.
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Mirkheshti, Alireza, Elham Memary, Hamed Shafiee, and Mastaneh Dahi. "Effect of dexmedetomidine infusion on N-terminal pro-B-type natriuretic peptide level in patients with femoral shaft fractures under general anesthesia." Bangladesh Journal of Pharmacology 11, no. 4 (2016): 765. http://dx.doi.org/10.3329/bjp.v11i4.27620.
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<p>This study was performed to assess the effect of dexmedetomidine on the level of N-terminal pro–B-type natriuretic peptide (NT-pro-BNP) in patients undergoing major orthopedic surgery. Patients undergoing general anesthesia for femoral shaft fracture surgery were randomly assigned to either 0.5 µg/kg/hour dexmedetomidine or normal saline. Changes in levels of NT-pro-BNP and hemodynamic parameters were compared. Data of 46 patients were analyzed and it was found that the change in NT-pro-BNP levels in the dexmedetomidine group was significantly less than the control group (p = 0.001). In addition, bleeding, changes in systolic and diastolic blood pressure in dexmedetomidine group was significantly less than the control group (p˂0.001). It is likely that dexmedetomidine infusion can reduce the rise of NT–pro-BNP level and therefore is associated with better cardiac outcome. In addition, dexmedetomidine infusion can achieve hemodynamic stability in femoral shaft fracture under general anesthesia.</p><p> </p>
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Wang, Yuzhong, Xiao-Xia Ming, and Cheng-Pan Zhang. "Fluorine-Containing Inhalation Anesthetics: Chemistry, Properties and Pharmacology." Current Medicinal Chemistry 27, no. 33 (2020): 5599–652. http://dx.doi.org/10.2174/0929867326666191003155703.
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Studies on fluorinated inhalation anesthetics, including synthesis, physical chemistry and pharmacology, have been summarized in this review. Retrospecting the history of inhalation anesthetics revealed their increasing reliance on fluorine and ether structures. Halothane causes a rare but severe immune-based hepatotoxicity, which was replaced by enflurane in the 1970s. Isoflurane replaced enflurane in the 1980s, showing modest advantages (e.g. lower solubility, better metabolic stability, and without convulsive predisposition). Desflurane and sevoflurane came into use in the 1990s, which are better anesthetics than isoflurane (less hepatotoxicity, lower solubility, and/or markedly decreased pungency). However, they are still less than perfect. To gain more ideal inhalation anesthetics, a large number of fluorinated halocarbons, polyfluorocycloalkanes, polyfluorocycloalkenes, fluoroarenes, and polyfluorooxetanes, were prepared and their potency and toxicity were evaluated. Although the pharmacology studies suggested that some of these agents produced anesthesia, no further studies were continued on these compounds because they showed obvious lacking as anesthetics. Moreover, the anesthetic activity cannot be simply predicted from the molecular structures but has to be inferred from the experiments. Several regularities were found by experimental studies: 1) the potency and toxicity of the saturated linear chain halogenated ether are enhanced when its molecular weight is increased; 2) the margin of safety decreases and the recovery time is prolonged when the boiling point of the candidate increases; and 3) compounds with an asymmetric carbon terminal exhibit good anesthesia. Nevertheless, the development of new inhalation anesthetics, better than desflurane and sevoflurane, is still challenging not only because of the poor structure/activity relationship known so far but also due to synthetic issues.
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Borin-Crivellenti, S., L. Z. Crivellenti, M. B. Carvalho, and A. E. Santana. "Bone marrow cytological evaluation in dogs with chronic kidney disease." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 66, no. 6 (2014): 1751–56. http://dx.doi.org/10.1590/1678-7739.
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Since anemia is indicated as an important compromising factor for the quality of life of dogs with chronic kidney disease (CKD), bone marrow cytological analysis may provide more information on the hematological profile these dogs and, therefore, allow clinicians to not only choose the most adequate treatment but also monitor the response to therapy. The aim of this study was to investigate the feasibility with sternal bone marrow puncture in chronic kidney disease (CKD) using only local anesthesia and check if the cytological analysis is helpful to determine the hematological status. We found that erythroid hypoplasia occurred only in terminal CKD patients, and that the bone marrows of dogs with CKD stages 2 and 3 were quantitatively similar to those of elderly dogs. All dogs tolerated the bone marrow puncture using only local anesthesia with lidocaine and bone marrow cytological evaluation may be a useful tool for hematopoietic evaluation of anemic dogs with CKD.
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Khokhlova, Oksana N., Natalya A. Borozdina, Elena S. Sadovnikova, et al. "Comparative Study of the Aftereffect of CO2 Inhalation or Tiletamine–Zolazepam–Xylazine Anesthesia on Laboratory Outbred Rats and Mice." Biomedicines 10, no. 2 (2022): 512. http://dx.doi.org/10.3390/biomedicines10020512.
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CO2 inhalation is currently the most common method of euthanasia for laboratory rats and mice, and it is often used for further terminal blood sampling for clinical biochemical assays. Lately, this method has been criticized due to animal welfare issues associated with some processes that develop after CO2 inhalation. The stress reaction and the value of the clinical laboratory parameters significantly depend on the used anesthetics, method, and the site of blood sampling. Especially in small rodents, an acute terminal state followed by a cascade of metabolic reactions that can affect the studied biochemical profile may develop and cause unnecessary suffering of animals. The aim of this study was to compare the stability of biochemical parameters of outbred Sprague Dawley rats and CD-1 mice serum collected after CO2 inhalation or the intramuscular injection of tiletamine–zolazepam–xylazine (TZX). The serum content of total protein and albumin, cholesterol, triglycerides, aspartate aminotransferase (AST), alanine aminotr ansferase (ALT), alkaline phosphatase (ALP), total bilirubin, and creatinine was decreased by the injection of TZX in comparison with CO2 inhalation. In addition, the levels of calcium, phosphates, chlorides and potassium were lowered by TZX vs. CO2 administration, while the level of sodium increased. Finally, the level of the majority of serum clinical biochemical parameters in rats and mice tend to be overestimated after CO2 inhalation, which may lead to masking the possible effect of anti-inflammatory drugs in animal tests. Injection anesthesia for small rodents with TZX is a more feasible method for terminal blood sampling, which also reduces the suffering of animals.
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Oleshchenko, I. G., A. V. Mankov, D. V. Zabolotskii, and S. V. Kuzmin. "Identification of risk predictors of undesirable hemorrhagic phenomena during retinal surgery in patients with diabetes mellitus on hemodialysis." Acta Biomedica Scientifica 9, no. 6 (2024): 149–55. https://doi.org/10.29413/abs.2024-9.6.15.
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A patient with diabetes mellitus (DM) complicated by nephropathy and retinopathy has changes in hemostasis, which poses a serious problem during retinal surgery and anesthesia using regional blockades.The aim. To determine the risk factors of undesirable hemorrhagic phenomena occurrence in DM patients being on programmed hemodialysis during regional anesthesia at the time of retinal pathology surgery.Materials and methods. A retrospective analysis of medical histories (for 2021– 2023) was performed. Age, gender, DM type, ASA score, duration of renal replacement therapy, time after last and before next hemodialysis, insulin therapy duration, diabetic retinopathy proliferative stage, general blood test, creatinine, blood sugar, APTT, undesirable hemorrhagic phenomena during retrobulbar anesthesia were recorded. Spearman correlation analysis was used to assess the relationship between the studied signs and hemorrhagic complications.Results. General blood test parameters evaluation revealed an average platelet count of 320 ± 47.5 × 109. Creatinine levels exceeded the norm by 5–7 times, which is typical for terminal chronic kidney failure (tCKF). APTT results before surgery did not go beyond reference values. The most significant correlations with an average positive relationship were established between the presence of hemorrhagic complications and the duration of the proliferative form of diabetic retinopathy (r = 0.67; p < 0.05), blood platelets number (r = 0.3; p < 0.05), creatinine level (r = 0.64; p < 0.05).Conclusion. During retinal pathology surgery, the duration of diabetic retinopathy proliferative form, uremic syndrome severity and thrombocytosis degree may be factors of undesirable hemorrhagic phenomena occurrence in patients with tCKF on programmed hemodialysis during regional anesthesia.
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Ugrenovic, Sladjana, Ivan Jovanovic, Vladislav Krstic, et al. "The level of the sciatic nerve division and its relations to the piriform muscle." Vojnosanitetski pregled 62, no. 1 (2005): 45–49. http://dx.doi.org/10.2298/vsp0501045u.
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Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome). The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities) which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases). In the remainder of the cases the sciatic nerve division was high (27.5% of the cases) in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases), while in 8 lower extremities (4% of the cases) the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases) and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases) common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases), must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.
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Hakan Demirel, Arif, İbrahim Kurtoğlu, Saygın Altıner, and Recep Aydın. "Repair of stoma prolapse with the “peristomal cerclage” method using vessel tape." Turkish Journal of Surgery 39, no. 4 (2023): 373–76. http://dx.doi.org/10.47717/turkjsurg.2023.6154.
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Stoma prolapse is one of the most common late complications following stoma construction. Although prolapses can be managed conservatively, they often require surgical revision. This study aimed to describe a revision method called peristomal cerclage applied with local anesthesia to treat stoma prolapse. A 66-year-old male patient with advanced rectal cancer underwent sigmoid loop colostomy one year ago due to a distal occlusive tumor. A revision of the colostomy prolapse that developed postoperatively was planned. After the reduction of the 12 cm prolapse into the abdomen under local anesthesia, a repair was performed in the form of peristomal wrapping of a vessel tape; except for short-term abdominal distension, no complications developed in the patient. He is currently in the postoperative 26th month and terminal period, and his colostomy is working normally. The present report aimed to describe the peristomal cerclage method, a minimally invasive revision procedure applied to patients with stoma prolapse, and to deliver its long-term results. It is important to report the results obtained with the more widespread use of this method.
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Li, Xiaoyu, and Bo Lu. "Severe bradycardia induced by postoperative nausea and vomiting: A case report." Medicine 102, no. 34 (2023): e34736. http://dx.doi.org/10.1097/md.0000000000034736.
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Introduction: Postoperative nausea and vomiting is a common complication for patients after anesthesia and surgery, which may result in increased parasympathetic activity, such as diaphoresis, pallor, or bradycardia. However, few cases of fatal bradycardia induced by postoperative nausea and vomiting have been reported before. Clinicians generally attribute bradycardia to certain anesthetics, instead of postoperative nausea or vomiting. Patient concerns: A fifty-year-old female with a history of well-controlled hypertension underwent elective radical mastectomy. When recovering from anesthesia in the post-anesthesia care unit, the patient experienced severe bradycardia accompanied by hypotension and unconsciousness, shortly after nausea and vomiting. Interventions: The patient received cardiopulmonary resuscitation immediately. Outcomes: Five minutes later, She recovered sinus rhythm and her vital sings tended to be stable. Three hours later, blood tests showed the N-terminal pro-B-type natriuretic peptide 127 pg/mL and cardiac troponin I 0.44 ng/mL, which peaked to 2.65 ng/mL 10 hours after the emergency. Electrocardiography revealed sinus rhythm, ST-segment depression in the inferior and anterior lateral leads, QTc prolongation, and left ventricular high voltage. Her serum cTnI continued to decline to 0.27 ng/mL on the 3rd day after surgery. She was discharged from the hospital on the fifth day and had no sequelae. Conclusion: Although postoperative nausea and vomiting occurs frequently, it should be kept in mind as a potential cause to blame for severe bradycardia or even life-threatening situations.
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Khvatova, A. V., M. B. Kodzov, Dmitriy Olegovich Arestov, A. V. Khvatova, M. B. Kodzov, and D. O. Arestov. "Method of non-invasive treatment for terminal glaucoma in children with congenital aniridia and buphthalmos." Russian Pediatric Ophthalmology 6, no. 1 (2011): 38–41. https://doi.org/10.17816/rpoj37464.
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A new method of non-invasive palliative treatment in terminal glaucoma stages in children taking into account the peculiarities of the eyes with congenital aniridia and buphthalmos (patent of the Russian Federation for invention ь2220691) was suggested. The method constitutes a diode laser trans-scleral cyclocoagulation (device OcuLight SLx; infrared spectrum, 810 ?m) with circulatory applications made at the ciliary body projection zone determined by means of diaphanoscopy except the zones of staphylomas and preceding surgery. Laser power mode depended on thickness of the sclera and the adherent tunics in the zone of future impact determined by ultrasonic B-scanning. Hypotensive effect was obtained in 84.6% of operations and remained in the long-term periods (3.9+0.4 years) in 61.5% of cases. The application of the aforesaid method allowed salvaging the eye as an organ without eyeball lancing with good cosmetic effect, at that in 84.6% of cases without anesthesia.
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Lee, Bong-Hee, Min-Yung Kim, and Woo-Kap Kim. "Projection of antennal receptor cell into subesophageal ganglion in insect." Proceedings, annual meeting, Electron Microscopy Society of America 48, no. 3 (1990): 438–39. http://dx.doi.org/10.1017/s0424820100159734.
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This investigation has been carried out to observe different types of synaptic organizations in subesophageal ganglion of Pieris rapae, then to examine the ultrastructure of degenerated antennal receptor terminals in ipsilateral subesophageal ganglion following the removal of an left antenna, and finally to identify which type of synapse is constituted in the subesophageal ganglion by the axon terminal of the receptor cell projecting from the antenna.For electron microscopy of normal synaptic organizations in the subesophageal ganglion, the general anesthesia of the one-day-old cabbage butterflies was performed in keeping them at 4°C for about 30 min. Thereafter, the heads were cut off from the butterflies with a razor blade and prefixed in 1% paraformaldehyde-1% glutaraldehyde at 4°C for 1 h. After being prefixed for 1 h, the heads were dissected under the stereoscope for getting the intact brains. The brains continued to be kept in a new prefixative at 4°C overnight of completing the fixation. They were washed in 0.4M phosphate buffer, pH 7.4, containing 7% glucose and 0.5% CaCl2, and postfixed in 2% OsO4 in phosphate buffer at 4°C for 2 h.
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SinemBahar, Celebi. "Malignant Hyperthermia Developed During Cardiac Pacemaker Operation." International Clinical and Medical Case Reports Journal 3, no. 6 (2024): 1–7. https://doi.org/10.5281/zenodo.12816568.
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Malignant hyperthermia (MH) is a rare but a terminal autosomal dominant myopathy that generally develops through inhalation anesthetics and/or depolarizing neuromuscular blocking agents. It has been associated with 70% ryanodine receptor gene mutation. MH crisis is as a result of malfunction in intracellular calcium mechanism, which is due to muscle rigidity and increasing in body temperature (1<sup>o</sup>C / 5 min.) that may advances to dissemine intravascular coagulation disorder (DIC), and its incidence is 1:14000-200000. MH is seen more common in men than women, and half of the reported cases consist of pediatric patients<sup>[1] </sup>. In this phenomenon 17-year-old female patient with congenital heart disease is presented, and while anesthesia was maintaining with sevoflurane during her permanent cardiac pacemaker installation operation, MH crisis was suspected. Since lack of dantrolene in our center, we could not give dantrolene to the patient, however thanks to the early and sufficient supportive care, she was discharged without remaining of any sequel. Although the patient was operated under general anesthesia before, it is noteworthy that the MH crisis has not been mentioned at patient’s anamnesis.
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Turchin, Radu, Gheorghe Guzun, Ruslan Baltaga, Andrei Badan, and Andrei Perciun. "Topographic Peculiarities of Interfascial Spaces in the Thoraco-Abdominal Region. Implications in Loco-Regional Anesthesia." Timisoara Medical Journal 2024, no. 3 (2024): 1. https://doi.org/10.35995/tmj20240216.
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Aim of the study. The objective is to study cellular spaces, as compartments lined with lax connective tissue, bounded by fascia, muscle, bone and other anatomical structures. They may contain different anatomical elements such as vessels, nerves and lymph nodes. According to their anatomic-topographic localization we distinguish: subcutaneous, interfascial, sub and interserosal, subfascial, osteo-fascial, parafascial, paravasosal, paraneural, paraarticular and paravisceral. Terminal branches of peripheral nerves are also located in them, thus there is the possibility to perform loco-regional blocks by injecting AL into the respective compartments. Material and Methods. This study is based both on the bibliographic analysis of the literature in the field of topographic anatomy and loco-regional anesthesia, and on our own experience within the ITA section of the Oncological Institute of Moldova. The chosen resources included fundamental textbooks and papers from recognized scientific journals published in the last 15 years. Results. Subfascial cellular spaces are located beneath the fascia propria (deep fascia) surrounding one or groups of muscles, between which are located intermuscular fascial septa or bony surfaces. According to recent research (including imaging methods) of the cellular space (interfascial plane), it is considered to be the space between two septa of the fascia propria (deep) and is presented by adipose tissue, elastin and reticular fibers. It may contain nerves, blood vessels, bone and muscle, and has a fixating, cushioning and lubricating role. Injecting AL into the interfascial space can block both the peripheral branches of nerves within the interfascial space and the nerve endings that distribute into the fascial fascia. Localization of the interfascial space to external landmarks alone is uncertain. Hence the advent of ultrasound with live, real-time visualization of anatomy has revolutionized both medical diagnosis and the technique of loco-regional anesthesia. Elsharkawy et al. suggested that the biomechanical properties of the fascia might play an important role in the diffusion of local anesthetics, and ultrasound can detect changes in the interfascial space during monitoring of LA dispersion. Conclusions. The knowledge of the anatomic-topographic particularities of the interfascial spaces allows us to understand the mechanism of action, indications, technique and complications of fascial plane anesthesia. With the widespread introduction of ultrasonography (especially hand-held ultrasonography), it became possible to visualize the anatomy in vivo: needle-layer relationship, nerves, vessels, local anesthetic spread. In this aspect the fascial plane blocks have shifted from techniques based on anatomic landmarks to ultrasonographic guidance, and their utilization is increasing.
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Macierewicz, J. A., J.-N. Albertini, and R. J. Hinchliffe. "A standardized aortic aneurysm model for the assessment of endovascular stent-graft technology." Vascular 19, no. 2 (2011): 82–88. http://dx.doi.org/10.1258/vasc.2010.oa0262.
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Reliable models of aortic aneurysms are required to test endovascular stent-graft technology prior to human use. We describe the creation of a standardized prosthetic aneurysm in an ovine model to assess endovascular technology. In an adult ovine model under general anesthesia, a polyester sphere measuring 6 cm across was sutured onto the infrarenal aorta following aortotomy. Two weeks later an endovascular stent-graft was deployed in the aorta. Exclusion was confirmed on monthly ultrasound duplex and during angiography at three months and under terminal anesthesia at six months. Autopsy along with histology of the specimen were then performed. A total of 10 sheep underwent aneurysm implantation. Nine received a straight tube endovascular stent-graft (Lombard Medical, Abingdon, Oxon, UK) and seven completed the study. Five prosthetic aneurysms shrank during serial imaging with duplex ultrasound and angiography. However, two remained the same size. One of these had a type I endoleak whereas the other had endotension (type I endoleak confirmed at autopsy). This animal model provides a reliable and reproducible method of creating prosthetic aneurysms for assessing endovascular stent-grafts. It was possible to assess aneurysm exclusion non-invasively using duplex ultrasound. Aneurysms effectively excluded from the circulation shrank whereas those with an endoleak did not.
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Harrop, James S., Gabriel E. Hunt, and Alexander R. Vaccaro. "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles." Neurosurgical Focus 16, no. 6 (2004): 1–23. http://dx.doi.org/10.3171/foc.2004.16.6.4.
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Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common. Unfortunately, a precise understanding of the pathophysiology and optimal treatments, including the best timing of surgery, has yet to be elucidated for either traumatic CES or CMS. In this paper the authors review the current literature on traumatic conus medullaris and cauda equina injuries and available treatment options.
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Sielenkämper, Andreas W., Kolja Eicker, and Hugo Van Aken. "Thoracic Epidural Anesthesia Increases Mucosal Perfusion in Ileum of Rats." Anesthesiology 93, no. 3 (2000): 844–51. http://dx.doi.org/10.1097/00000542-200009000-00036.
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Background Previous studies reported that thoracic epidural anesthesia (TEA) protected against a decrease in gastric intramucosal pH, suggesting that TEA increased gut mucosal perfusion. The current study examines the effects of TEA on ileal mucosa using intravital microscopy in anesthetized rats. Methods Nineteen rats were equipped with epidural catheters, with the tip placed at T7 through T9. Rats were anesthetized and mechanically ventilated. After midline abdominal incision, the ileum was prepared for intravital microscopy. Videomicroscopy on the ileal mucosa was performed before and after epidural infusion of 20 microliter of bupivacaine 0.4% (TEA group, n = 11 rats) or normal saline (control group, n = 8 rats). Microvascular blood flow in ileum mucosa was assessed offline using computerized image analysis. Results Control rats exhibited unchanged mean arterial pressure and microvascular perfusion. During TEA, mean arterial pressure was decreased compared with the control group (93 +/- 10 vs. 105 +/- 9 mmHg; P &lt; 0.05). Epidural bupivacaine increased red cell velocity in terminal arterioles from 888 +/- 202 to 1,215 +/- 268 micrometer/s (control, 793 +/- 250 to 741 +/- 195 micrometer/s; P &lt; 0.001 between groups). Because arteriolar diameter was not affected, this increase in red cell velocity may represent an increase in arteriolar blood flow. Total intercapillary area (inversely related to perfused capillary density) was unchanged, but for the TEA group the difference between total intercapillary area and the intercapillary area calculated for continuously perfused capillaries was decreased compared with the control group (16 +/- 12 vs. 40 +/- 19%; P &lt; 0.001), indicating a decrease in intermittent (stop-and-go) blood flow in the villus microcirculation. Conclusion Thoracic epidural anesthesia increased gut mucosal blood flow and reduced intermittent flow in the villus microcirculation in the presence of a decreased perfusion pressure.
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González-Suárez, Susana, John Camacho Oviedo, José Maria Suriñach Caralt, et al. "Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism." Journal of Clinical Medicine 14, no. 8 (2025): 2704. https://doi.org/10.3390/jcm14082704.
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Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged ≥18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO2 <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 ± 11660.86 and 2388.50 ± 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO2 < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA.
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Saiki, Chikako, and Shigeji Matsumoto. "Digastric muscle activities in anoxic infant rats." Canadian Journal of Physiology and Pharmacology 82, no. 11 (2004): 960–68. http://dx.doi.org/10.1139/y04-104.
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The digastric muscle acts for both feeding (including mastication and swallowing) and respiration. In this study, we examined whether or not the muscle activity is detectable during anoxia in developing rats. Rats at 4 different ages, days 5, 10, 16, and 24, were exposed to 100% N2 under pentobarbital or ketamine–xylazine anesthesia, and the electromyograms of digastric muscles (dEMG) and the diaphragm (diaEMG) were examined simultaneously. Prior to the anoxic exposure, at all ages, the dEMG was similar to or less apparent than the diaEMG, which was detected at each inspiratory movement. In anoxia, we first observed dEMG activity, mostly sporadic (days 5 and 10) or mostly tonic (days 16 and 24), when diaEMG activity was temporarily suppressed (we termed it Phase 1). Second, synchronous phasic or tonic dEMG and phasic diaEMG were recorded temporarily before terminal apnea (we termed it Phase 2). These phenomena were also obtained in vagotomized rats (all ages) or in rats injected with the N-methyl-D-aspartate receptor antagonist MK-801 (dizocilpine (5R,10S)-(+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine hydrogen maleate) (days 16 and 24). In conclusion, our results suggest that in anoxia, dEMG activity is detectable during diaEMG suppression in early anoxia, irrespective of the developmental age, the anesthetic (pentobarbital or ketamine–xylazine), vagotomy, or MK-801 injections.Key words: newborn, hypoxia, apnea, swallowing, trigeminal nerve.
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Daly, Curt M., Karen Swalec-Tobias, Anthony H. Tobias, and Nicole Ehrhart. "Cardiopulmonary Effects of Intrathoracic Insufflation in Dogs." Journal of the American Animal Hospital Association 38, no. 6 (2002): 515–20. http://dx.doi.org/10.5326/0380515.
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This study was designed to quantify the effects of incremental positive insufflation of the intrathoracic space on cardiac output (CO), heart rate (HR), arterial pressure (AP), central venous pressure (CVP), and percent saturation of hemoglobin with oxygen (SPO2) in anesthetized dogs. Seven healthy, adult dogs from terminal teaching laboratories were maintained under anesthesia with isoflurane delivered with a mechanical ventilator. The experimental variables were recorded before introduction of an intrathoracic catheter, at intrathoracic pressures (IP) of 0 mm Hg, 3 mm Hg insufflation, and additional increments of 1 mm Hg insufflation thereafter until the SPO2 remained &lt;85% despite increases in minute volume. Finally the variables were measured again at 0 mm Hg IP. The cardiac output and systolic and diastolic AP significantly (P&lt;0.05) decreased at 3 mm Hg IP. Significant decreases in SPO2 were seen at 10 mm Hg IP. Significant increase in CVP was noted at 6 mm Hg IP. Heart rate decreased significantly at 5 to 6 mm Hg IP but was not decreased above 6 mm Hg IP. Given the degree of CO decrease at low intrathoracic pressures, insufflation-aided thoracoscopy should be used with caution and at the lowest possible insufflation pressure. Standard anesthetic monitoring variables such as HR and AP measurements may not accurately reflect the animal’s cardiovascular status.
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Liu, Pengfei, Quansheng Gao, Lei Guan та ін. "Atorvastatin attenuates surgery-induced BBB disruption and cognitive impairment partly by suppressing NF-κB pathway and NLRP3 inflammasome activation in aged mice". Acta Biochimica et Biophysica Sinica 53, № 5 (2021): 528–37. http://dx.doi.org/10.1093/abbs/gmab022.
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Abstract In clinic, perioperative neurocognitive disorder is becoming a common complication of surgery in old patients. Neuroinflammation and blood–brain barrier (BBB) disruption are important contributors for cognitive impairment. Atorvastatin, as a strong HMG-CoA reductase inhibitor, has been widely used in clinic. However, it remains unclear whether atorvastatin could prevent anesthesia and surgery-induced BBB disruption and cognitive injury by its anti-inflammatory property. In this study, aged C57BL/6J mice were used to address this question. Initially, the mice were subject to atorvastatin treatment for 7 days (10 mg/kg). After a simple laparotomy under 1.5% isoflurane anesthesia, Morris water maze was performed to assess spatial learning and memory. Western blot analysis, immunohistochemistry, and enzyme-linked immunosorbent assay were used to examine the inflammatory response, BBB integrity, and cell apoptosis. Terminal-deoxynucleotidyl transferase mediated nick end labeling assay was used to assess cell apoptosis. The fluorescein sodium and transmission electron microscopy were used to detect the permeability and structure of BBB. The results showed that anesthesia and surgery significantly injured hippocampal-dependent learning and memory, which was ameliorated by atorvastatin. Atorvastatin could also reverse the surgery-induced increase of systemic and hippocampal cytokines, including IL-1β, TNF-α, and IL-6, accompanied by inhibiting the nuclear factor kappa-B (NF-κB) pathway and Nucleotide-Binding Oligomerization Domain, or Leucine Rich Repeat and Pyrin Domain Containing 3 (NLRP3) inflammasome activation, as well as hippocampal neuronal apoptosis. In addition, surgery triggered an increase of BBB permeability, paralleled by a decrease of the ZO-1, occludin, and Claudin 5 proteins in the hippocampus. However, atorvastatin treatment could protect the BBB integrity from the impact of surgery, by up-regulating the expressions of ZO-1, occludin, and Claudin 5. These findings suggest that atorvastatin exhibits neuroprotective effects on cognition in aged mice undergoing surgery.
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Merskey, Harold, and Robert W. Teasell. "The Disparagement of Pain: Social Influences on Medical Thinking." Pain Research and Management 5, no. 4 (2000): 259–70. http://dx.doi.org/10.1155/2000/565309.
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Patients with pain often feel that their suffering is taken lightly, dismissed or denied. Before the introduction of anesthesia, pain was regarded as an awful affliction. This view diminished somewhat once anesthesia became available, although it still holds true for some forms of pain, eg, pain associated with terminal cancer. Pain was then treated as less troublesome when it became a reason for disability compensation to be paid. Examples are given of the disparagement of complaints by individuals reporting pain in the past 150 years. Factors that encourage doctors to underestimate patients' pain include the requirement for doctors to control the issue of narcotics; circumstances in which patients may benefit from compensation by claiming that their pain is great; and the development of attitudes that understate the importance of the relief of pain and overstate the importance of activity, exercise and not complaining. Current attitudes in this respect are associated with the insurance industry, but it has been shown that, even patients who do not have a compensable injury or have pain that is not disabling fail to receive the treatment for pain that is appropriate, eg, postoperatively. The present paper reviews and discusses these problems and suggests that disparagement of pain and disability in the medicolegal field also leads to the rejection of pain in other contexts.
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Lien, Cynthia A., Virginia D. Schmith, Matthew R. Belmont, Amy Abalos, David F. Kisor, and John J. Savarese. "Pharmacokinetics of Cisatracurium in Patients Receiving Nitrous Oxide/Opioid/Barbiturate Anesthesia." Anesthesiology 84, no. 2 (1996): 300–308. http://dx.doi.org/10.1097/00000542-199602000-00007.
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Background Cisatracurium, one of the ten isomers in atracurium, is a nondepolarizing muscle relaxant with an intermediate duration of action. It is more potent and less likely to release histamine than atracurium. As one of the isomers composing atracurium, it presumably undergoes Hofmann elimination. This study was conducted to describe the pharmacokinetics of cisatracurium and its metabolites and to determine the dose proportionality of cisatracurium after administration of 2 or 4 times the ED(95). Methods Twenty ASA physical status 1 or 2 patients undergoing elective surgery under nitrous oxide/opioid/barbiturate anesthesia were studied. Patients received a single rapid intravenous bolus does of 0.1 or 0.2 mg x kg-1 (2 or 4 times the ED(95), respectively) cisatracurium. All patients were allowed to recover spontaneously to a train-of-four ratio &gt; or = 0.70 after cisatracurium-induced neuromuscular block. Plasma was extracted, acidified, and stored frozen before analysis for cisatracurium, laudanosine, the monoquaternary acid, and the monoquaternary alcohol metabolite. Results The clearances (5.28 +/- 1.23 vs. 4.66 +/- 0.67 ml x min(-1) x kg(-1) and terminal elimination half-lives (22.4 +/- 2.7 vs. 25.5 +/- 4.1 min) were not statistically different between patients receiving 0.1 mg x kg(-1) and 0.2 mg x kg(-1), respectively. Maximum concentration values for laudanosine averaged 38 +/- 21 and 103 +/- 34 ng x ml(-1) for patients receiving the 0.1 and 0.2 mg x kg(-1) doses, respectively. Maximum concentration values for monoquaternary alcohol averaged 101 +/- 27 and 253 +/- 51 ng x ml(-1), respectively. Monoquaternary acid was not quantified in any plasma sample. Conclusions Cisatracurium undergoes Hofmann elimination to form laudanosine. The pharmacokinetics of cisatracurium are independent of dose after single intravenous doses of 0.1 and 0.2 mg x kg(-1).
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Viani, Marco P., Giacomo M. Viani, and Jessica Sergenti. "One-shot scleroembolization: a new technique for the treatment of varicose veins disease of lower extremities. Preliminary results." Phlebology: The Journal of Venous Disease 29, no. 10 (2013): 694–97. http://dx.doi.org/10.1177/0268355513499556.
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Objective The aim of this article is to present a new technique for minimally invasive treatment of varicose veins disease of lower extremities. Methods One-shot scleroembolization is a new technique designed for the treatment of varicose veins of the lower extremities, which associates a mechanical interruption of the sapheno-femoral junction to classic sclerotherapy with no need for surgery or anesthesia. This is achieved with the combined use of a coil positioned in the terminal portion of the great saphenous vein and a foamed sclerosant drug. Results At three months’ follow-up no complications have been observed. The great saphenous vein was still occluded in all patients (nine out of nine). Conclusions One-shot scleroembolization seems to be an effective technique for the treatment of varicose veins disease in outpatients, with the advantage of causing little distress to the patient.
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Jurca, A. M., A. Stanila, A. Gajta, D. Stanila, and A. Panga. "Treatment effectiveness of dry eye syndrome among computer users." Medicine in Evolution 27, no. 3 (2021): 179–85. http://dx.doi.org/10.70921/medev.v27i3.1117.
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The aim of the study is to evaluate the symptoms of dry eye syndrome among computer users and to evaluate the effectiveness of treatment with various topical medication (artificial tears). The investigative methods used were: Ocular surface disease index questionnaire (OSDI), based on 12 questions related to subjective ocular signs and symptoms that occurred during various activities of daily living, the Schirmer I test (without anesthesia), tear break-up time (T-BUT) and tear pH. In this study were admitted 35 subjects, video terminal operators (VDT), 12 Male (M) and 23 Female (F), average age of 38.51 years, with signs and symptoms of dry eyes, no acute ocular pathology, no previous eye surgery and no topical drugs administered two months before the study. The results show an improvement in symptoms after one month of treatment with topical medication.
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Ahmed, Naveed, Mian Sarfraz Gul, Hafiz Khalid Pervaiz, Iftikhar Ahmed, Mujahid Zulfiqar Ali, and Shafaqat Ali. "IMPACT OF ENDEMICITY OF ASCARIASIS ON DIAGNOSIS OF ACUTE APPENDICITIS." PAFMJ 71, no. 5 (2021): 1567–70. http://dx.doi.org/10.51253/pafmj.v71i5.5694.
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Objective: To determine the impact of endemicity of ascariasis in the manifestation of acute appendicitis.
 Study Design: Prospective observational study.
 Place and Duration of Study: General Surgery Department, Combined Military Hospital Skardu, from May 2012 to Apr 2015.
 Methodology: Patients presenting with symptoms of acute appendicitis were included in the study. Patients were diagnosed after taking detailed history, clinical examination and blood chemistry. All the patients underwent open appendectomy under general anesthesia. Per-operatively presence of worms was assessed in terminal ileum and after that in the lumen of the appendix initially by palpation and then by opening its lumen after it was removed. Histopathologic diagnosis could not be confirmed due to its non-availability as the surgeries were performed in a remote and resource constraint area of the country.
 Results: A total of 224 patients were included in the study. Out of these, 143 (63.8%) were male and 81 (36.1%) female patients. The mean age of patients was 22 ± 6 years. Per-operatively, 21 (9.3%) patients had worms in both ileum and appendicular lumen while 22 (9.8%) patients had worms only in the terminal ileum and there were no worms seen in either ileum or appendix in 181 (80.8%) patients.
 Conclusion: There is a relation of parasitic infestation especially Ascaris lumbricoides in the manifestation of acute appendicitis in endemic areas.
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Александрин, В. В., А. В. Иванов, and А. А. Кубатиев. "Wavelet analysis of cerebral blood flow in terminal rats." Nauchno-prakticheskii zhurnal «Patogenez», no. 1 (March 31, 2022): 69–73. http://dx.doi.org/10.25557/2310-0435.2022.01.69-73.
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В последнее десятилетие внимание клиницистов привлекает проблема церебральной гипоперфузии - диапазона ишемического мозгового кровотока от нижней границы ауторегуляции до порога некроза. Поиски методов исследования регуляции кровотока при гипоперфузии остаются актуальным научным направлением. Цель исследования. Изучить посредством лазерной допплеровской флоуметрии (ЛДФ) состояние регуляторных влияний на микрососуды мозга в условиях тяжелой ишемии. Материалы и методы. Эксперименты проведены на 10 контрольных и 10 опытных крысах под наркозом (хлоралгидрат, 400 мг/кг, в/б). Регистрацию мозгового кровотока (МК) проводили к неокортексе посредством ЛДФ. С помощью вейвлет-анализа ЛДФ-грамм анализировали регуляторные влияния со стороны эндотелия, нервной системы, миоцитов, дыхательных экскурсий и пульса. Результаты. В контроле при среднем артериальном давлении (АД) 84 [83; 86] мм рт.ст. МК составлял 27 [22, 32] п.е. В опытной группе после снижения системного АД до 30 [28; 31] мм рт.ст. (МК) составлял 6 (4, 7) п.е, что соответствует тяжелой ишемии. Абсолютные показатели колебаний кровотока при этом значимо снижались: в миогенном (в 2 раза), дыхательном (2,7 раза) и пульсовом (1,4 раза) диапазонах спектра. В то же время относительный вклад эндотелиального и нейрогенного диапазонов увеличился в 2,4 раза и 1,9 раза соответственно, что отражает процесс снижения тонуса церебральных сосудов в условиях централизации кровообращения. Заключение. Вейвлет-анализ мозгового кровотока позволяет выявить тонкие особенности его регуляции со стороны механизмов, формирующих сосудистый тонус. In the last decade, the attention of clinicians has focused on cerebral hypoperfusion, the range of ischemic cerebral blood flow from the lower border of autoregulation to the threshold of necrosis. The search for methods of studying the regulation of blood flow in hypoperfusion remains highly relevant. Aim. To study regulatory influences on cerebral microvessels in the conditions of severe ischemia by laser Doppler flowmetry (LDF). Materials and methods. The experiments were performed on 10 control and 10 experimental rats under anesthesia (chloral hydrate, 400 mg/kg, i/b). Cerebral blood flow (CBF) was recorded in the neocortex by LDF. Regulatory influences from the endothelium, nervous system, myocytes, respiratory excursions and pulse were studied by the wavelet analysis of LDF-grams. Results. In the control with an average blood pressure (BP) of 84 [83; 86] mm Hg, the CBF was 27 [22, 32] p. u. In the experimental group, after a decrease in systemic BP to 30 [28; 31] mm Hg, the CBF was 6 [4, 7] p. u., which corresponded to severe ischemia. Absolute values of blood flow fluctuations significantly decreased in the myogenic (50%), respiratory (63%) and pulse (28.6%) ranges. Furthermore, the relative contributions of the endothelial and neurogenic ranges increased by 140% and 90%, respectively, which reflects the process of reducing the tone of cerebral vessels in the conditions of centralization of blood circulation. Conclusion. The wavelet analysis of CBF reveals subtle features of its regulation by the mechanisms that form vascular tone.
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Mao, Zemei, Wanju Wang, Haixia Gong, Yinghui Wu, Yang Zhang, and Xinlei Wang. "Upregulation of miR-496 Rescues Propofol-induced Neurotoxicity by Targeting Rho Associated Coiled-coil Containing Protein Kinase 2 (ROCK2) in Prefrontal Cortical Neurons." Current Neurovascular Research 17, no. 2 (2020): 188–95. http://dx.doi.org/10.2174/1567202617666200506101926.
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Objective: Early exposure to general anesthesia in children might be a potentially highrisk factor for learning and behavioral disorders. The mechanism of neurotoxicity induced by general anesthesia was not defined. miR-496 could regulate cerebral injury, while the roles of miR- 496 in neurotoxicity were not elucidated. Therefore, we aimed to investigate the effects of miR- 496 in neurotoxicity induced by propofol. Methods: Primary Prefrontal Cortical (PFC) neurons were isolated from neonatal rats and treated with propofol to induce neurotoxicity. Cell viability was detected by (3-(4,5-Dimethylthiazol- 2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and cell apoptosis was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The target relationship of miR-496 and Rho Associated Coiled-Coil Containing Protein Kinase 2 (ROCK2) was explored using luciferase assays. Results: Propofol decreased cell viability, promoted cell apoptosis, and decreased the expression of miR-496 in PFC neurons in a dose-dependent manner. Overexpression of miR-496 attenuated neurotoxicity induced by propofol in PFC neurons. ROCK2 was a target of miR-496, and miR-496 oppositely modulated the expression of ROCK2. Besides, propofol increased the expression of ROCK2 through inhibiting miR-496 in PFC neurons. Overexpression of miR-496 attenuated propofol- induced neurotoxicity by targeting ROCK2 in PFC neurons. Conclusion: miR-496 was decreased in PFC neurons treated with propofol, and overexpression of miR-496 attenuated propofol-induced neurotoxicity by targeting ROCK2. miR-496 and ROCK2 may be promising targets for protecting propofol-induced neurotoxicity.
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Khokhlova, Oksana N., Elena A. Tukhovskaya, Irina N. Kravchenko, et al. "Using Tiletamine-Zolazepam-Xylazine Anesthesia Compared to CO 2 -inhalation for Terminal Clinical Chemistry, Hematology, and Coagulation Analysis in Mice." Journal of Pharmacological and Toxicological Methods 84 (March 2017): 11–19. http://dx.doi.org/10.1016/j.vascn.2016.10.005.
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Lucchinetti, Eliana, Lukas Bestmann, Jianhua Feng, et al. "Remote Ischemic Preconditioning Applied during Isoflurane Inhalation Provides No Benefit to the Myocardium of Patients Undergoing On-pump Coronary Artery Bypass Graft Surgery." Anesthesiology 116, no. 2 (2012): 296–310. http://dx.doi.org/10.1097/aln.0b013e318242349a.
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Background Two preconditioning stimuli should induce a more consistent overall cell protection. We hypothesized that remote ischemic preconditioning (RIPC, second preconditioning stimulus) applied during isoflurane inhalation (first preconditioning stimulus) would provide more protection to the myocardium of patients undergoing on-pump coronary artery bypass grafting. Methods In this placebo-controlled randomized controlled study, patients in the RIPC group received four 5-min cycles of 300 mmHg cuff inflation/deflation of the leg before aortic cross-clamping. Anesthesia consisted of opioids and propofol for induction and isoflurane for maintenance. The primary outcome was high-sensitivity cardiac troponin T release. Secondary endpoints were plasma levels of N-terminal pro-brain natriuretic peptide, high-sensitivity C-reactive protein, S100 protein, and short- and long-term clinical outcomes. Gene expression profiles were obtained from atrial tissue using microarrays. Results RIPC (n = 27) did not reduce high-sensitivity cardiac troponin T release when compared with placebo (n = 28). Likewise, N-terminal pro-brain natriuretic peptide, a marker of myocardial dysfunction; high-sensitivity C-reactive protein, a marker of perioperative inflammatory response; and S100, a marker of cerebral injury, were not different between the groups. The incidence for the perioperative composite endpoint combining new arrhythmias and myocardial infarctions was higher in the RIPC group than the placebo group (14/27 vs. 6/28, P = 0.036). However, there was no difference in the 6-month cardiovascular outcome. N-terminal pro-brain natriuretic peptide release correlated with isoflurane-induced transcriptional changes in fatty-acid metabolism (P = 0.001) and DNA-damage signaling (P &lt; 0.001), but not with RIPC-induced changes in gene expression. Conclusions RIPC applied during isoflurane inhalation provides no benefit to the myocardium of patients undergoing on-pump coronary artery bypass grafting.