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   Table of Contents - Current issue
July-September 2022
Volume 12 | Issue 3
Page Nos. 73-115

Online since Monday, November 29, 2021

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Current research progress of isoflurane in cerebral ischemia/reperfusion injury: a narrative review p. 73
Shu-Jun Chen, Xia-Qing Yuan, Qun Xue, Hai-Feng Lu, Gang Chen
DOI:10.4103/2045-9912.330689  PMID:34854416
Cerebral ischemia/reperfusion injury is an important factor leading to poor prognosis in ischemic stroke patients. Therefore, it is particularly important to find effective remedial measures to promote the health of patients to return to society. Isoflurane is a safe and reliable anesthetic gas with a long history of clinical application. In recent years, its protection function to human body has been widely recognized, and nowadays isoflurane for cerebral protection has been widely studied, and the stable effect of isoflurane has satisfied many researchers. Basic studies have shown that isoflurane’s protection of brain tissue after ischemia/reperfusion involves a variety of signaling pathways and effector molecules. Even though many signaling pathways have been described, more and more studies focus on exploring their mechanisms of action, in order to provide strong evidence for clinical application. This could prompt the introduction of isoflurane therapy to clinical patients as soon as possible. In this paper, several confirmed signaling pathways will be reviewed to find possible strategies for clinical treatment.
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Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study p. 77
Esmail Moshiri, Hesameddin Modir, Alireza Kamali, Mehran Azami, Morteza Molouk
DOI:10.4103/2045-9912.330690  PMID:34854417
This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier’s block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.
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Effects of different fresh gas flows and different anesthetics on airway temperature and humidity in surgical patients: a prospective observational study p. 83
Irem Gumus Ozcan, Ozkan Onal, Aysun Ozdemirkan, Ali Saltali, Mehmet Sari
DOI:10.4103/2045-9912.330691  PMID:34854418
This study was aimed to investigate the effects of different fresh gas (oxygen + air) flow rates and different anesthetics on airway temperature and humidity when using the same anesthesia machine in patients undergoing general anesthesia. In this prospective, observational study, 240 patients with American Society of Anesthesiologists (ASA) I–II between the age of 18–65 years to be operated under general anesthesia were enrolled and divided into two groups according to the fresh gas flow rate (3–6 L/min). Each of the two main groups was further divided into three subgroups according to the administered anesthetic gases and drugs. The resulting six groups were further divided into two subgroups according to whether the heat and humidity exchanger filter (HME) was attached to the breathing circuit, and the study was carried out on a total of 12 groups. The temperature and humidity of the inspired air were recorded every 10 minutes using an electronic thermo-hygrometer. The inspired temperature and humidity were greater in patients ventilated at 3 L/min compared to the 6 L/min group and in HME (+) patients compared to HME (–), regardless of the type of anesthetics. HME application makes the air more physiological for the respiratory tract by increasing the temperature and humidity of the air regardless of the anesthetic agent. This study was approved by Ethics Committee Review of Selcuk University Faculty of Medicine (No. 2017/261) in September 2017, and was registered in the Clinical Trial Registry (identifier No. NCT04204746) on December 19, 2019.
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Hydrogen-rich bath with nano-sized bubbles improves antioxidant capacity based on oxygen radical absorbing and inflammation levels in human serum p. 91
Yoshiharu Tanaka, Li Xiao, Nobuhiko Miwa
DOI:10.4103/2045-9912.330692  PMID:34854419
This study compared the effects of hydrogen-water (HW) bath on the oxygen radical absorption-based antioxidant capacity and the inflammatory indicator, C-reactive protein (CRP), in serum between healthy volunteers and inflammatory/collagen disease-patients. The HW bath apparatus supplied nano-bubbles with a diameter of 110 ± 10 nm and 338–682 μg/L of dissolved hydrogen after 120 minutes electrolysis, and nano-bubbles increased to 9.91 × 107/mL along with the increase of correlative dissolved hydrogen. Ten-minute HW bath increased the oxygen radical absorption-based antioxidant capacity to 110.9 ± 9.2% at post-bathing 120 minutes, although unaltered with 10-minute normal water bath at 40°C in healthy subjects. The CRP level was repressed to 70.2 ± 12.1% at 120 minutes after HW bath, although rather increased for normal water bath. In the patients with connective tissue diseases, the CRP level was repressed to 3–24% upon 9 days to 4 months of HW bathing. In another six patients with diverse autoimmune-related diseases, upon daily HW bathing as long as 2–25 months, the pre-bathing CRP level of 5.31 mg/dL decreased to 0.24 mg/dL being within the standard-range, with relief of visible inflammatory symptoms for some cases. Thus, the HW bath with high-density nano-bubbles has beneficial effects on serum antioxidant capacity, inflammation, and the skin appearance. The study was approved by the Committee of Ethics, Japanese Center of Anti-Aging Medical Sciences (Authorization No. H-15-03-2, on January 15, 2019), which was a non-profitable organization officially authenticated by the Hiroshima Prefecture Government of Japan.
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Color change after tooth bleaching with ozone and 10% ozonized carbamide peroxide for in-office use p. 100
Thalyta dos Reis Furlani Zouain Ferreira Neves Dias, Francisco Ubiratan Ferreira de Campos, Cecilia Pedroso Turssi, Flávia Lucisano Botelho do Amaral, Fabiana Mantovani Gomes França, Roberta Tarkany Basting
DOI:10.4103/2045-9912.330693  PMID:34854420
There is a constant search for bleaching treatments that can offer greater safety with fewer adverse effects, especially in the techniques performed in the office, which usually employ hydrogen peroxide in high concentrations (35% to 40%) that are not recommended by some international control agencies. This in vitro study evaluated the color change after tooth bleaching with the use of ozone and a 10% ozonized carbamide peroxide bleaching treatment for in-office use. Thirty molars were allocated (n = 10): three applications of ozone (1 hour every 3 days); three applications of 10% ozonized carbamide peroxide (1 hour every 3 days); 10% carbamide peroxide agent (8 hours a day for 7 days). The teeth were mounted on a plaster model to simulate the dental arch, and trays made of silicone were used for the application of the bleaching agents and to allow ozone to enter through. The ozone concentration used was 60 μg/mL, with an oxygen flow of 0.25 L/min. The values of color change showed no significant differences among treatments. The variations in the parameters over time, as well as the values of ΔEab, ΔE00, and WID, showed that there was no significant difference among the three treatments. The use of ozone and 10% ozonized carbamide peroxide for in-office use was effective for tooth bleaching with clinically perceptible and acceptable color alterations. The study was approved on September 10, 2019 by the São Leopoldo Mandic Ethics Research Committee (CAAE No. 17711719.4.0000.5374).
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In vivo microelectrode monitoring of real-time hydrogen concentration in different tissues of rats after inhaling hydrogen gas p. 107
Bo-Yan Liu, Jun-Li Xue, Qian-Qian Gu, Min Zhao, Meng-Yu Zhang, Ming-Yue Wang, Yun Wang, Shu-Cun Qin
DOI:10.4103/2045-9912.330694  PMID:34854421
Medical effects of hydrogen have been reported in many studies. Due to difficulties in measuring hydrogen concentration in vivo after intake and high explosive risks of hydrogen, studies about dose-response relationships and tissue concentrations of hydrogen are few. Here, for the first time, we monitored real-time hydrogen concentrations in different tissues in rats including brain, liver, spleen, kidney, thigh muscle, inguinal white adipose tissue, and gonadal white adipose tissue after inhaling different concentrations of hydrogen (4%, 42%, and 67%) using an electrochemical sensor. Hydrogen concentrations in the same tissue showed a dose-dependent response. The equilibrium concentration values were highest in the brain and lowest in the thigh muscle. The saturation and desaturation curves changed more slowly in the thigh muscle and white adipose tissues than in other tissues. These results provide fundamental information for the selection of hydrogen dose applications in basic research and clinical trials. The experiments were approved by the Laboratory Animal Ethics Committee of Shandong First Medical University & Shandong Academy of Medical Sciences (No. 2020-1028) on March 18, 2020.
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Spuriously low end tidal carbon dioxide in capnometry: Nafion tube malfunction in end tidal carbon dioxide module blamed for near mishap! p. 113
Suma Rabab Ahmad, Chitta Ranjan Mohanty, Snigdha Bellapukonda, Bishu Prasad Patro
DOI:10.4103/2045-9912.330695  PMID:34854422
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Anesthesiologists and burnout: what are we missing? p. 115
Priyanka Bansal, Kunal Bansal
DOI:10.4103/2045-9912.330696  PMID:34854423
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