Anesthetic Properties Research Articles

English

BACKGROUND Spinal Anaesthesia is the most commonly used form of anaesthesia for surgeries below the level of umbilicus. Bupivacaine is the drug of choice for subarachnoid block. Spinal anaesthesia with bupivacaine is associated with many side effects and complications especially in patients with multiple co-morbid conditions. In our study we compared the anaesthetic effectiveness of 3.5 ml hyperbaric bupivacaine with a mixture of 100 mg ketamine and 0.1 mg adrenaline, the solution is made hyperbaric by adding 1.4 ml of 5 % dextrose given intrathecally. The objective of our study was to compare the anaesthetic properties and clinical effectiveness of intrathecally administered ketamine with bupivacaine for inguinal hernia repair. METHODS This randomised control study was conducted on fifty American society of Anaesthesiologists (ASA) 1 and 2 patients in the age group of 25 – 60 years posted for elective inguinal hernia repair from December 2004 to December 2005. They were randomized in to two groups. Group 1 (Bupivacine group) and Group 2 (Ketamine group). Bupivacaine group (group 1) received 3.5 ml of bupivacaine heavy and ketamine group (group 2) received preservative free ketamine 100 mg with 0.1 mg adrenalin 1/1000 solution in 1.4 ml of 5 % dextrose to make it heavy. Anaesthetic properties, side effects and complications of both groups were compared intraoperatively. RESULTS The onset of action of ketamine (1.58 minutes) was faster than bupivacaine (3.31 minutes) which is statistically significant. Duration of blockade was longer in bupivacaine group (sensory 227.92 and motor 203.08) compared to ketamine group (sensory 143.40 and motor 109.46). Ketamine group showed a greater level of haemodynamic stability than bupivacaine group. CONCLUSIONS Intrathecal ketamine produces optimal anaesthetic conditions for surgeries like inguinal hernia repair. Haemodynamic stability provided by intrathecal ketamine is beneficial in patients with multiple comorbidities. KEYWORDS Hyperbaric Bupivacaine, Ketamine in Hyperbaric Solution, Intrathecal Block, Inguinal Hernia Repair

Novel poly herbal muco-adhesive formulation for treatment of oral aphthous ulcer

Background: Oral ulcers are the most frequent lesions that cause discomfort for which the patients seek treatment for alleviating pain and facilitate early healing. Various treatment modalities from modern medicine and Ayurveda are used in the form of ointments and mouthwashes with varying efficacy. Anti-inflammatory medicines, enzymatic preparations, gamma globulins and immune suppressants have been used.Methods: Extracts of five chosen herbs, Glycyrrhiza glabra, Acacia catechu, Punica Granatum, Curcuma longa and Mentha piperita were used for preparing mucoadhesive gel for the treatment of oral aphthous ulcers of any etiology. Gel was prepared by cold method of Schmolka at M/s Pharmanza Herbals Pvt. Ltd., India. Five formulations were prepared with using different concentration of active pharmaceutical ingredient (API) extracts.Results: Formulations were analyzed for different physical and chemical properties. Preliminary trial was done with five formulations. The F5 formulation has the premier viscosity because of its higher polymer content; it is able to remain on mucous surface long enough to release its API effect. Since the uniformity, proper appearance, stability and acceptable viscosity and gel strength the F1 formulation was selected as the superior formulation which could prove ideal for treatment of oral aphthous ulcers.Conclusions: The results provide strong evidence that polyherbal gel containing extracts of Glycyrrhiza glabra, Acacia catechu, Punica granatum, Curcuma longa and Mentha piperita on the basis of their analgesic, anti-inflammatory, antioxidant, wound healing, antimicrobial and local anesthetic properties can be used as an effective and safe alternative for the management of aphthous ulcers.

Evaluation of Antivenom Activity of Cassia alata Leaf Extract against Daboia Russelii Venom

Cassia alata, commonly known as candle bush, ringworm bush is an extensively distributed plant of the family Leguminosea. It is an annual and occasionally biannual herb, flowering in the sunshine and humid areas, with an average height of 1 to 4m. Biological activity in plants has been claimed to be effective as antidiabetic, antimicrobial, antioxidant, anti-inflammatory, anti-allergic, antimicrobial, analgesic, anti-ulcer, antiviral, antidepressants, hepatoprotective, antimalarial, anthelmintic, cardiovascular, and anesthetic properties. The ethanolic extract of plant was subjected first time for neutralization of snake venom activity. Primary phytochemical screening shows the existence of alkaloid, steroids, phenols, flavonoids, and triterpenoids. Ethanolic extract of Cassia alata plants was tested for antivenom activity against Daboia russelii venom. Various dose levels of leaf extract 200 and 400mg/kg showed significant neutralization of hemorrhagic activity, and at 400mg/kg leaf extract showed significant necrotizing activity in rats.

Predicting the Membrane Permeability of Fentanyl and Its Analogues by Molecular Dynamics Simulations

The lipid membrane is considered a crucial component of opioid general anesthesia. The main drug used for the induction and maintenance of opioid anesthesia is fentanyl and its various analogues. However, these drugs have different clinical effects, and detailed atomic-level insight into the drug–membrane interactions could lead to a better understanding how these drugs exert their anesthetic properties. In this study, we have used extensive umbrella sampling molecular dynamics simulations to study the permeation process of fentanyl and three of its analogues into a variety of simple phospholipid membrane models. Our simulations show that we can accurately predict the permeability coefficients of these drug molecules, which is an important process in understanding how pharmaceuticals reach their molecular targets. We were also able to show that one phospholipid provides more accurate predictions than other lipids commonly used in these types of permeation studies, which will aid future studies of these types of processes.

Nanoemulsion boosts anesthetic activity and reduces the side effects of Nectandra grandiflora Nees essential oil in fish

Nectandra grandiflora essential oil has become an alternative to synthetic anesthetics and sedation in fish. However, essential oil volatility, light sensitivity, and low water-solubility may limit its use in the fish farm. To overcome these drawbacks, we developed a new nanoemulsion product that may be applied as an anesthetic. We evaluated the anesthetic property and safety of free essential oil (FEO) and its nanoemulsion (NEN) for Nile tilapia (Oreochromis niloticus). Formulations were made using the spontaneous emulsification process, and stability was tested for NEN and FEO at 4, 25, and 40 °C for 90 days. The NEN contained 95% of FEO, the major compounds remained stable up to 60 days, and the NEN protected the active substances at all temperatures. Fish behavior was observed during a bath with FEO and NEN 3–300 mg/L concentrations for 30 min. The difference between sedated and anesthetized fish was detected by their swimming behavior and response to stimuli on the caudal peduncle. Behavior score, survival, or adverse effects were accessed with 10 and 30 mg/L concentrations of FEO and NEN during 24 h exposure and 72 h recovery. Only 100 mg/L of NEN induced anesthesia without side effects. Long-term exposure tests confirmed the 30 mg/L NEN safety, with a 100% survival rate for fish exposed to NEN and a 25.5% survival rate for fish exposed to surfactants. Therefore, this poorly water-soluble essential oil was converted into a novel sedative and anesthetic for fish through nanoemulsion. Thus, nanoemulsion protects the essential oil and improves the pharmacological activity, with the suggested use of 30 mg/L during 24 h, for sedation, and 100 mg/L, for anesthesia.

Recreational ketamine-related deaths notified to the National Programme on Substance Abuse Deaths, England, 1997-2019.

Background:Ketamine is a phencyclidine derivative with dissociative anaesthetic properties. Increasing numbers of individuals in England take ketamine recreationally. Information on deaths arising from such use in England is presented.Methods:Cases were extracted on 31 January 2020 from the National Programme on Substance Abuse Deaths database, based on text searches of the cause of death, coroner’s verdict and positive toxicology results for the terms ‘ketamine’ or ‘norketamine’.Findings:During 1997–2005, there were <5 deaths p.a. in which ketamine was implicated. Numbers increased until 2009 (21), plateauing until 2016; thereafter, deaths have risen to about 30 p.a. Decedents’ characteristics (N = 283): male 84.1%, mean age 31.2 (SD 10.0) years, employed 56.5%, drug use history 79.6% and living with others 60.3%. Ketamine was detected with other substances in most cases. Main (74.6%) underlying cause of death was accidental poisoning. Ketamine may have impaired judgement in other cases.Conclusions:Although controlled, recreational ketamine use and related fatalities continue to increase. Consumers need to be more aware of the potentially fatal risks they face.

Badania wyciągów z liści, kwiatów, owoców i gałązek Padus avium Mill.

Introduction. The bird cherry (Padus avium Mill.) belongs to the Rosaceae family and is common in Poland. In various parts of the plant, among others, flavonoids, anthocyanins, phenolic compounds, cyanogenic glucosides, tannins, essential oil, organic acids and sugars are present. They determine astringent, anti-inflammatory, estrogenic, anesthetic, antidiabetic, cytotoxic and antibacterial properties. Aim. Determination of antioxidant activity and sum of polyphenols in leaves, flowers, fruits and young branches of bird cherry, as well as confirmation of the presence of selected flavonoids and phenolic acids. Material and methods. The research material was leaves, flowers, fruit and young twigs of Padus avium, collected from a natural site in the Noteć Forest (near Sieraków). The contents of the sum of polyphenols in the prepared extracts were determined by spectrophotometric method using the Folin-Ciocalteu (FC) reagent and the antioxidant activity by the DPPH radical method and the FRAP method, and the presence of selected flavonoids and phenolic acids was confirmed by thin-layer and paper chromatography. Results. In water and methanol extracts, the highest content of polyphenols (%) in terms of coffee acid was found in leaves (6.91 ± 0.30%; 9.02 ± 0.34%), and the lowest in fruits (2.05 ± 0, 11%; 3.11 ± 0.11%). Water and methanol extracts from leaves showed the highest antioxidant activity and the weakest water extracts from fruit (DPPH and FRAP methods). 1D-TLC, 2D-TLC and tissue paper (PC) analysis revealed the presence of rutoside in flowers and twigs, hyperoside in leaves, flowers, fruits and twigs, and most likely ferulic and vanillic acids in fruits and twigs, chlorogenic and coffee acids in all raw materials from the bird cherry. Conclusions. The highest content of polyphenolic compounds was determined in black cherry leaves, both in water and methanol extracts. The water and methanol extracts from the leaves showed the strongest antioxidant activity. The presence of rutoside, hyperoside and some phenolic acids was confirmed in the tested raw materials.

The intraperitoneal ondansetron for postoperative pain management following laparoscopic cholecystectomy: A proof-of-concept, double-blind, placebo-controlled trial

BackgroundPain after laparoscopic cholecystectomy remains a major challenge. Ondansetron blocks sodium channels and may have local anesthetic properties. AimsTo investigate the effect of intraperitoneal administration of ondansetron for postoperative pain management as an adjuvant to intravenous acetaminophen in patients undergoing laparoscopic cholecystectomy. MethodsPatients scheduled for elective laparoscopic cholecystectomy were randomized into two groups (n = 25 each) to receive either intraperitoneal ondansetron or saline injected in the gall bladder bed at the end of the procedure. The primary outcome was the difference in pain from baseline to 24-h post-operative assessed by comparing the area under the curve of visual analog score between the two groups. ResultsThe derived area under response curve of visual analog scores in the ondansetron group (735.8 ± 418.3) was 33.97% lower than (p = 0.005) that calculated for the control group (1114.4 ± 423.9). The need for rescue analgesia was significantly lower in the ondansetron (16%) versus in the control group (54.17%) (p = 0.005), indicating better pain control. The correlation between the time for unassisted mobilization and the area under response curve of visual analog scores signified the positive analgesic influence of ondansetron (rs =0.315, p = 0.028). The frequency of nausea and vomiting was significantly lower in patients who received ondansetron than that reported in the control group (p = 0.023 (8 h), and 0.016 (24 h) respectively). ConclusionsThe added positive impact of ondansetron on postoperative pain control alongside its anti-emetic effect made it a unique novel option for patients undergoing laparoscopic cholecystectomy.

Histopathological alterations in gills, kidney and liver of Nile Tilapia (Oreochromis niloticus) fingerlings exposed to aqueous leaf extract of Desert Date (Balanites aegyptiaca)

One of the many biomarkers for determining the effects of pollutants on fish is changes in organ histopathology. Leaves of Balanites aegyptiaca have been reported to have phytochemicals with fish anaesthetic property. This study sought to determine the effect of graded acute concentrations (200.00, 250.00, 300.00.350.00 and 400.00 mg/L) of B. aegyptiaca on histopathology of gills, kidney and liver of mixed sex of Oreochromis niloticus fingerlings. A total of 120 O. niloticus fingerlings (mean weight 23±0.03 g and mean total length 12.50±0.39 cm) were exposed to the plant extract. Paraffin wax method and haematoxylin-eosin staining techniques of tissue processing were adopted for the examination of the gills, kidney and liver. Dose-dependent histopathological changes were observed in the three organs (gills, kidney and liver) i.e. histopathological alterations increase with increase in concentration of the plant extract. Gills showed lamellae fusion, haemorrhage, desquamation, atrophy and secondary lamellae erosion while kidney and liver indicated atrophy, necrosis, haemorrhage, hyperplasia and hypertrophy. Structural alterations were evident in the gills, kidney and liver of O. niloticus fingerlings exposed to the concentrations of aqueous crude leaf extract of B. aegyptiaca therefore it should be used with caution during fish anaesthesia.&#x0D; Keywords: Histopathology; Gill; Kidney; Liver; Balanites aegyptiaca; Oreochromis niloticus.

A comparative study between the effect of verapamil versus nalbuphine as an adjuvant in supraclavicular brachial plexus block

BackgroundBrachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline.ResultsResults of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block.ConclusionBoth drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

Mechanical Nociceptive Threshold, Tissue Alterations and Horn Growth in Calves after Injection of Isoeugenol or Clove Oil under the Horn Bud.

Simple SummaryHot-iron disbudding of calves is a common but painful practice. We investigated the injection of clove oil or isoeugenol under the horn bud as a potential alternative. Compared to hot-iron disbudding (with local anesthesia), pain sensitivity increased much less and for a shorter time in isoeugenol-injected calves. After injection of clove oil, the differences to hot-iron disbudding were smaller, and there was a high occurrence of swellings of the eyelids. Neither injection was as effective as the use of a hot iron in preventing horn growth. In sum, the injection of clove oil is not recommendable, and regarding the use of isoeugenol further research is needed, in particular on possibilities to improve its effectiveness.Disbudding of calves is a common, painful intervention. Due to cytotoxic and anesthetic properties, the injection of clove oil or its component isoeugenol may be less detrimental to animal welfare. We investigated mechanical nociceptive threshold (MNT), possible tissue alterations and horn growth for up to 12 weeks after injection of 1.5 mL clove oil (CLOV), isoeugenol (ISO) or saline (CON) or after hot-iron disbudding (BURN; with local anesthesia and sedation, n = 10/treatment). MNT was measured using von Frey filaments and a pressure algometer at four locations around the horn bud. There was a treatment*time point interaction (linear mixed model, p < 0.05). MNT decreased most strongly and for the longest time for BURN in most calves at least for 3 weeks. For ISO, the decrease was less distinct and most calves’ values returned to baseline after 1–2 weeks. MNT in CLOV was intermediate, with decreased values up to 3 weeks in some animals. 12 weeks after the treatment, horn growth was prevented in about 50% of the horns in CLOV and ISO. Tissue alterations such as swellings of the eyelids often occurred in CLOV, but less so in ISO. Our results suggest that injection of isoeugenol causes less pain and thus seems to be beneficial compared to hot-iron disbudding, while clove oil was not advantageous. Regarding the effectiveness of isoeugenol to prevent horn growth, more studies are needed.

Anaesthetics and plants: from sensory systems to cognition-based adaptive behaviour

Plants are not only sensitive to exogenous anaesthetics, but they also produce multitudes of endogenous substances, especially when stressed, that often have anaesthetic and anelgesic properties when applied to both humans and animals. Moreover, plants rely on neurotransmitters and their receptors for cell-cell communication and integration in a similar fashion to the use of neural systems in animals and humans. Plants also use their plant-specific sensory systems and neurotransmitter-based communication, including long-distance action potentials, to manage stress via cognition-like plant-specific behaviour and adaptation.

In vitro and in vivo evaluation of a lidocaine loaded polymer nanoparticle formulation co-loaded with lidocaine for local anesthetics effect

There is a crucial need for long-acting local anesthetics (LAs) that can be administered as single dose analgesics. However, owing to their low molecular mass, LAs (lidocaine, bupivacaine, procaine, ropivacaine, and benzocaine) display rapid and complete absorption. The goal of the current study (LDC@LPHNs) was to progress and assess lidocaine (LDC) hybrid lipid-polymer nanoparticles (LPHNs) in comparison to LDC-loaded PLGA NPs (LDC@NPs). The morphology, zeta potential, particle size, and drug loading abilities of the newly fabricated materials were examined. The self-assembled LDC@LPHNs combined with PLGA, DSPE-PEG2000, and lecithin were approximately 180 nm in size, were larger than LDC@LPHNs and LDC@NPs and showed a protracted in vitro drug release profile in PBS solution. Additionally, the LDC@LPHNs exhibited improved stability and less in vitro cytotoxicity. Furthermore, in vivo examination of the anesthetic properties in mice models showed that the LDC@LPHNs displayed remarkable protracted analgesic durations, which was further confirmed through histological examinations. These outcomes establish that the LDC@LPHNs could purpose as a potential framework of drug conveyance to address the disadvantages of less stability, quick release of drug, and to extend anesthetic effects with less toxicity.

Inhalational anesthetics

Inhalational anesthetics have been used for induction and maintenance of general anesthesia for more than 150years. All of the currently used inhalational anesthetics are chlorinated and fluorinated derivatives of ether. Dosing is carried out using the minimal alveolar concentration (MAC) concept. The pharmacokinetic properties of the various inhalational anesthetics are governed by the specific distribution coefficients. Mechanisms of action include specific modulations of various receptors of the central nervous system as well as an unspecific interaction with the cell membrane. Organ toxicity of modern inhalational anesthetics is considered to be minimal. The role of inhalational anesthetics in the context of postoperative nausea and vomiting (PONV) has been reassessed in recent years. The superiority of inhalational anesthetics over intravenous hypnotics with respect to intraoperative awareness is undisputed. The organ protective mechanism of preconditioning is an exclusive property of inhalational anesthetics among all the currently available hypnotics.

The effect of volatile anesthetics on cellular responses in the microcirculation of free tissue transfers.

The purpose of this review was to summarize the anti-inflammatory and immunosuppressive properties of volatile anesthetics and present their potential impact on the outcomes of major surgical procedures as well as microsurgical cases of free tissue transfer. Inhaled anesthetics are commonly used as a component of general anesthesia in interventional procedures, reconstructive surgery, free tissue transfers and transplantation. Experimental and clinical studies have shown that volatile anesthetics such as halothane, sevoflurane, isoflurane or desflurane can affect the immune system of patients exposed to general anesthesia. In patients with no serious systemic diseases, this effect is transient and mostly clinically irrelevant. However, in patients subjected to the inflammatory response due to the active disease, cardiac or pulmonary failure or advanced age, the prognosis may improve or worsen following inhalation anesthesia depending on the type of systemic pathology. The available data from reported clinical trials, as well as the in vitro and in vivo experimental studies, have often reported conflicting statements regarding the impact of inhalation anesthetics on outcomes of surgical procedures. These differences may be due to the heterogeneity of the evaluated patients, the extent and duration of surgical procedures, and different experimental design and methodologies applied for assessment of the reported clinical and research studies. In this review, based on the available literature reports we have summarized the anti-inflammatory and immunosuppressive effects as well as cellular responses of inhalation anesthetics at the microcirculatory level and discussed their potential clinical implications for the outcomes of surgical procedures of free tissue transfers.

The individualised Pharmacologic approach of Enhanced Recovery After Surgery (ERAS) pathways: Analgesics and local anaesthetics

Background: Enhanced Recovery After Surgery (ERAS) is multidisciplinary, evidence-based approach in the perioperative care of surgical patients that aims to reduce postoperative complications, length of hospital stay, readmissions and healthcare costs by implementing protocols throughout patient’s perioperative journey. (1) The purpose of this review is to highlight the pharmacologic perspective of the most common drugs utilised in ERAS protocols, present current evidence regarding optimal and individualised use of them, discuss ways how clinicians can maximise the benefits of their patients and outline future advancements in the field. Methods: A wide literature search was performed to identify high quality evidence on the pharmacology of common analgesics and local anaesthetics used in ERAS protocols. PubMed, Embase and Scopus databases were searched using various combinations of terms related to perioperative analgesia, personalised/precision/individualised medicine, local anaesthetics and Enhanced Recovery after Surgery protocols, up to January 2021. Results: Literature search revealed known and less known pharmacological properties of common analgesics and local anaesthetics, unveiled pharmacodynamic, pharmacokinetic and pharmacogenomic properties of drugs that can improve efficiency and reduce adverse-effects with a more individualised patient approach and suggested evidence-based ways of serving the purposes of ERAS protocols. Conclusions: Clinical Pharmacology plays an essential role in improving patient care within ERAS pathways by implementing basic and advanced pharmacologic properties and pharmacogenomic data towards a more patient-centered approach.

An examination of the relationship between molecular dipole moment and blood-gas partition for common anaesthetic gases.

The solubility of inhalational anaesthetics in the bloodstream is related to the minimum alveolar concentration (MAC), which is an indicator of anaesthetic gas potency. The blood-gas partition coefficient (Kbg) is a measure of how much anaesthetics bind to plasma proteins in the blood compared to air. Just like the octanol-water partition coefficient, the Kbg may be related to the molecular dipole moment (μ), which can be modulated by the molecular conformation. Our quantum-chemical calculations demonstrated that subtle stereoelectronic interactions, namely those responsible for the anomeric and gauche effects, control the conformational equilibrium of some widely used volatile fluorinated anaesthetics and, consequently, of their molecular dipole moments. Since a remarkable correlation between empirical Kbg and calculated μ was found for these anaesthetics, the average molecular dipole moments may be used to predict the anaesthetic gas potency and other properties, such as lipid solubility, of inhalational anaesthetic analogs.

Comparative evaluation of pain perception following topical application of clove oil, betel leaf extract, lignocaine gel, and ice prior to intraoral injection in children aged 6-10 years: a randomized control study.

BackgroundIn the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children.MethodsSixty children aged 6–10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion. The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05.ResultsThe clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant.ConclusionBetel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.

Anesthetic potential of the essential oils of Aloysia triphylla, Lippia sidoides and Mentha piperita for Colossoma macropomum

The aim of this study was to evaluate the anesthetic potential of the essential oils of Aloysia triphylla (EOAT), Lippia sidoides (EOLS) and Mentha piperita (EOMP) in relation to juvenile tambaqui (Colossoma macropomum), based the swimming behavior of these fish and possible histopathological damage to the gills. To induce anesthesia, juvenile tambaqui (130.55 ± 22.4 g; 16.8 ± 0.95 cm) were individually exposed to different concentrations of the essential oils (EOAT: 5, 10, 20, 40, 60, 80 and 150 mg L−1; EOLS: 2, 5, 10, 20, 30, 40 and 50 mg L−1; EOMP: 5, 10, 20, 40, 60, 70 and 90 mg L−1), for exposure periods of between four minutes and six hours. The three essential oils evaluated presented anesthetic properties. The concentration intervals over which the fish reached all the stages of anesthesia (1, 2, 3a, 3b and 4) were between 40 and 150 mg L−1 for EOAT; 20 and 50 mg L−1 for EOLS; and 40 and 90 mg L−1 for EOMP. The times taken to reach the anesthesia stages were inversely proportional to the increases in the concentration of the essential oils. The histopathological damage to the gills of the tambaqui that resulted from using essential oil concentrations that were defined as anesthetic (150 mg L−1 EOAT, 30 mg L−1 EOLS and 90 mg L−1 EOMP) were also evaluated. The main damage recorded was hypertrophy and hyperplasia of the lamellar epithelium, lamellar fusion and proliferation of chloride cells. According to the histopathological alteration index (HAI), there were no irreversible damage (such as fibrosis and necrosis) to the gills of the tambaqui. However, while EOLS and EOMP caused mild damages in the gills, the EOAT generated more severe damages. Overall, for the tambaqui, the essential oils of A. triphylla, L. sidoides and M. piperita are efficient anesthetic in the doses of 150, 30 and 90 mg L−1, respectively.

Buffered 2% articaine versus non-buffered 4% articaine in maxillary infiltration: randomized clinical trial.

This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration.