Saline Infusion Group Research Articles

Prophylactic infusion of norepinephrine does not affect the rostral spread of spinal anesthesia in pregnancy: a prospective, randomized, double-blinded study.

Background: The infusion of phenylephrine to prevent spinal-induced hypotension (SIH) in cesarean delivery may decrease the rostral spread of a spinal local anesthetic. We hypothesized that infusion of norepinephrine may decrease the rostral spread of spinal anesthesia, similar to that caused by phenylephrine. The aim of this study was to compare the block height of spinal anesthesia in the presence or absence of norepinephrine infusion administered to prevent SIH during cesarean delivery. Methods: Eighty patients were enrolled and allocated into groups receiving a norepinephrine infusion (group N) or saline infusion (group C). After intrathecal injection of hyperbaric bupivacaine 10mg, the block height for cold and pinprick sensation was checked 10 and 20min after the injection. The demographic characteristics, spinal anesthesia, side effects, and neonatal outcomes were also recorded. Results: The block height for cold and pinprick sensation was similar between the two groups, although the incidence of hypotension was significantly lower (p < 0.00) in group N than in group C. Systolic blood pressure was also more stable in group N than in group C, with the incidence of interventions being significantly lower in group N. There was no significant difference in patient satisfaction between the two groups. Conclusion: Evidence from this study suggested that prophylactic norepinephrine infusion does not reduce the rostral spread of spinal anesthesia in pregnancy. We suggest that it is not necessary to increase the dose of an intrathecal local anesthetic for cesarean delivery when prophylactic norepinephrine is administered. Clinical Trial Registration: https://www.chictr.org.cn/bin/project/edit?pid=152899, identifier [ChiCTR2200057439].

Oxytocin Infusion versus Vaginal Misoprostol in Reducing Blood Loss during Abdominal Myomectomy: A Randomized Controlled Trial

Background Uterine myomas are most prevalent benign tumors in reproductive-aged women. Myomectomy is an alternative to hysterectomy for women who wish to retain their uterus but it is associated with higher risk of blood loss, greater operative time and need for blood transfusion. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. Aim of the Work The aim of the study is to compare between the efficacy of intraoperative oxytocin infusion and preoperative vaginal misoprostol in reducing blood loss during abdominal myomectomies. Methods In a prospective randomized controlled trial which was conducted at Ain shams maternity Hospital in Cairo from July 2017 to May 2021.100 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled. Patients were randomly assigned to 2 groups. Group O (Oxytocin group) patients (n = 50) received 30 U oxytocin in 500 ml normal saline infusion intraoperative and Group M (Misoprostol group) An hour before the operation, patients (n = 50) received a single dose of vaginal misoprostol (400 μg). The primary outcome was the operative blood loss. The secondary outcomes were the need for blood transfusion, change in hemoglobin (Hb) and hematocrit (Hct) levels 24 h after operation, conversion to hysterectomy, hospitalization and the prevalence of side effects. Results Intra-operative blood loss was significantly lower in those women randomized to receive vaginal misoprostol versus the oxytocin infusion group (458.5 ± 115.4 mL vs 618.8 ± 115.1 ml {P = &amp;lt; 0.001}). Misoprostol group showed lower mean blood loss by – 160.3 ml (95% CI -206.0 to -114.6) and reduced need for blood transfusion (RR 0.22, 95% CI 0.005 to 0.98) {P = 0.025}. Additionally, there was a highly significant statistical difference between Misoprostol group and Oxytocin group as regards the postoperative hemoglobin, hematocrit concentration, operative time as Misoprostol group showed a higher postoperative hemoglobin and hematocrit concentration, and less operative time. There was no difference in the patient demographics, intraoperative characteristics, postoperative stay, complications, and the side effects between the two groups. Conclusion As evident from the current study, pre-operative misoprostol in abdominal myomectomy is a safe and reliable method that offers some practical advantages, such as reducing intra-operative blood loss and blood transfusion needs

In Vivo Validation of Modulated Acoustic Radiation Force-Based Imaging in Murine Model of Abdominal Aortic Aneurysm Using VEGFR-2-Targeted Microbubbles.

The objective of this study is to validate the modulated acoustic radiation force (mARF)-based imaging method in the detection of abdominal aortic aneurysm (AAA) in murine models using vascular endothelial growth factor receptor 2 (VEGFR-2)-targeted microbubbles (MBs). The mouse AAA model was prepared using the subcutaneous angiotensin II (Ang II) infusion combined with the β-aminopropionitrile monofumarate solution dissolved in drinking water. The ultrasound imaging session was performed at 7 days, 14 days, 21 days, and 28 days after the osmotic pump implantation. For each imaging session, 10 C57BL/6 mice were implanted with Ang II-filled osmotic pumps, and 5 C57BL/6 mice received saline infusion only as the control group. Biotinylated lipid MBs conjugated to either anti-mouse VEGFR-2 antibody (targeted MBs) or isotype control antibody (control MBs) were prepared before each imaging session and were injected into mice via tail vein catheter. Two separate transducers were colocalized to image the AAA and apply ARF to translate MBs simultaneously. After each imaging session, tissue was harvested and the aortas were used for VEGFR-2 immunostaining analysis. From the collected ultrasound image data, the signal magnitude response of the adherent targeted MBs was analyzed, and a parameter, residual-to-saturation ratio ( Rres - sat ), was defined to measure the enhancement in the adherent targeted MBs signal after the cessation of ARF compared with the initial signal intensity. Statistical analysis was performed with the Welch t test and analysis of variance test. The Rres - sat of abdominal aortic segments from Ang II-challenged mice was significantly higher compared with that in the saline-infused control group ( P < 0.001) at all 4 time points after osmotic pump implantation (1 week to 4 weeks). In control mice, the Rres - sat values were 2.13%, 1.85%, 3.26%, and 4.85% at 1, 2, 3, and 4 weeks postimplantation, respectively. In stark contrast, the Rres - sat values for the mice with Ang II-induced AAA lesions were 9.20%, 20.6%, 22.7%, and 31.8%, respectively. It is worth noting that there was a significant difference between the Rres - sat for Ang II-infused mice at all 4 time points ( P < 0.005), a finding not present in the saline-infused mice. Immunostaining results revealed the VEGFR-2 expression was increased in the abdominal aortic segments of Ang II-infused mice compared with the control group. The mARF-based imaging technique was validated in vivo using a murine model of AAA and VEGFR-2-targeted MBs. Results in this study indicated that the mARF-based imaging technique has the ability to detect and assess AAA growth at early stages based on the signal intensity of adherent targeted MBs, which is correlated with the expression level of the desired molecular biomarker. The results may suggest, in very long term, a pathway toward eventual clinical implementation for an ultrasound molecular imaging-based approach to AAA risk assessment in asymptomatic patients.

Intraductal pressure in experimental models of acute and chronic pancreatitis in mice

Background/ObjectivesPancreatic intraductal pressure is related to the development of pancreatitis, including post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis. In this study, we investigate pancreatic intraductal pressure in various mouse models of acute and chronic pancreatitis. MethodsPost-ERCP pancreatitis was induced by retrograde infusion of normal saline or radiocontrast at the constant rate of 10 or 20 μL/min. Obstructive pancreatitis was induced by ligation of the pancreatic duct followed by a single injection of caerulein and the changes of intraductal pressure were recorded in day 3 for obstructive acute pancreatitis and day 14 for obstructive chronic pancreatitis. Non-obstructive pancreatitis was induced by repetitive intraperitoneal injections of caerulein. The changes of intraductal pressure were recorded right after the last caerulein injection for non-obstructive acute pancreatitis and after the completion of 4-week caerulein injections for non-obstructive chronic pancreatitis. ResultsElevated pancreatic intraductal pressure was observed in both normal saline and radiocontrast infusion groups and was furtherly indicated that was positively correlated with the viscosity of solution but not genders. In the models of obstructive pancreatitis, a rise in intraductal pressure was observed in both acute and chronic pancreatitis; whereas in the models of non-obstructive pancreatitis, a rise in intraductal pressure was only observed in chronic, but not acute pancreatitis. ConclusionsDuring ERCP, the elevations in pancreatic intraductal pressure are induced by increasing rate or viscous solution of infusion. During different forms of experimental acute and chronic pancreatitis, obstructive or non-obstructive etiologies of pancreatitis also induces the elevations in pancreatic intraductal pressure.

Examination of central nervous system by functional observation battery after massive intravenous infusion of carbon monoxide-bound and oxygen-bound hemoglobin vesicles in rats

Carbon monoxide (CO) is known as a toxic gas inducing “CO poisoning”, which acutely affects the central nervous system (CNS) and which persistently affects brain functions depending on the exposure time and CO concentration. By contrast, in pathological rodent models, intravenous infusion of CO-bound hemoglobin vesicles (CO-HbV) has shown various beneficial effects such as anti-oxidative and anti-inflammatory reactions. This study assessed effects of CO-HbV infusion on CNS using a functional observation battery, sensory reflexes, grip strength, and landing foot splay measurements. The test fluids were CO-HbV and O2-bound HbV (O2-HbV) suspended in saline ([Hb] ​= ​10 ​g/dL), and saline alone for comparison. The rats received either 16 or 32 ​mL/kg of fluid intravenously at 1.5 ​mL/min/kg. Observations were made before infusion, and at 5 ​min, 4, 8, 24, 48 and 72 ​h after infusion. Massive doses of 16 and 32 ​mL/kg respectively corresponded to about 29 and 57% of the whole circulating blood volume (56 ​mL/kg). No toxicological effect was observed in any measurement item for any group in comparison to the control saline infusion group. Histopathological examination of hippocampal tissue at 14 days after infusion showed the number of necrotic cells to be minimal. Results obtained from rats in this experiment suggest that the massive intravenous infusion of CO-HbV yields beneficial anti-oxidative and anti-inflammatory effects without showing CO-poisoning-related symptoms of CNS damage.

Prophylactic Phenylephrine Increases the Dose Requirement of Oxytocin to Treat Uterine Atony During Cesarean Delivery: A Double-Blinded, Single-Center, Randomized and Placebo-Controlled Trial.

Purpose: Studies involving mouse models and human uterine smooth muscle cells have shown that phenylephrine inhibits uterine contractions in non-pregnant mice and human in vitro cell via cyclic adenosine monophosphate (cAMP) signaling. However, there has been no limited exploration to date of the effect of phenylephrine on uterine contractions in clinical practice. This study aimed to compare the dose requirement of oxytocin with or without the infusion of prophylactic phenylephrine to prevent post spinal hypotension during cesarean delivery under combined spinal and epidural anesthesia. Methods: This was a double-blinded, single-center, randomized, control study. One hundred and sixty pregnant patients provided informed consent and were randomly allocated to the phenylephrine (phenylephrine infusion) and control (saline infusion) groups. Patients randomized to the phenylephrine group received an intravenous prophylactic phenylephrine infusion at a fixed rate of 0.5 μg/kg/min. The control group received a saline placebo at the same rate and used the same apparatus for delivery. After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol. The primary outcome measure was the total dose of oxytocin administered during CD. Secondary outcomes including the proportion (%) of patients requiring a secondary uterotonic agent and estimated blood loss (EBL) in the first 24 h after surgery. Results: The median oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine group than in the control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperatively was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22). Conclusions: Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are now needed to confirm these findings.

GLP-1 vasodilatation in humans with coronary artery disease is not adenosine mediated

BackgroundIncretin therapies appear to provide cardioprotection and improve cardiovascular outcomes in patients with diabetes, but the mechanism of this effect remains elusive. We have previously shown that glucagon-like peptide (GLP)-1 is a coronary vasodilator and we sought to investigate if this is an adenosine-mediated effect.MethodsWe recruited 41 patients having percutaneous coronary intervention (PCI) for stable angina and allocated them into four groups administering a specific study-related infusion following successful PCI: GLP-1 infusion (Group G) (n = 10); Placebo, normal saline infusion (Group P) (n = 11); GLP-1 + Theophylline infusion (Group GT) (n = 10); and Theophylline infusion (Group T) (n = 10). A pressure wire assessment of coronary distal pressure and flow velocity (thermodilution transit time—Tmn) at rest and hyperaemia was performed after PCI and repeated following the study infusion to derive basal and index of microvascular resistance (BMR and IMR).ResultsThere were no significant differences in the demographics of patients recruited to our study. Most of the patients were not diabetic. GLP-1 caused significant reduction of resting Tmn that was not attenuated by theophylline: mean delta Tmn (SD) group G − 0.23 s (0.27) versus group GT − 0.18 s (0.37), p = 0.65. Theophylline alone (group T) did not significantly alter resting flow velocity compared to group GT: delta Tmn in group T 0.04 s (0.15), p = 0.30. The resulting decrease in BMR observed in group G persisted in group GT: − 20.83 mmHg s (24.54 vs. − 21.20 mmHg s (30.41), p = 0.97. GLP-1 did not increase circulating adenosine levels in group GT more than group T: delta median adenosine − 2.0 ng/ml (− 117.1, 14.8) versus − 0.5 ng/ml (− 19.6, 9.4); p = 0.60.ConclusionThe vasodilatory effect of GLP-1 is not abolished by theophylline and GLP-1 does not increase adenosine levels, indicating an adenosine-independent mechanism of GLP-1 coronary vasodilatation.Trial registration: The local research ethics committee approved the study (National Research Ethics Service-NRES Committee, East of England): REC reference 14/EE/0018. The study was performed according to institutional guidelines, was registered on http://www.clinicaltrials.gov (unique identifier: NCT03502083) and the study conformed to the principles outlined in the Declaration of Helsinki.

Dexmedetomidine infusion on subarachnoid block with bupivacaine in inguinal herniorrhaphies - A prospective study

Background: Dexmedetomidine (D) is alpha-2 agonist that acts as an anaesthetic and analgesic substitute. The goal of this study was to see how intravenous (I.V.) dexmedetomidine affected the length of sensory and motor block, postoperative analgesia, sedation degree, and side effects. Aims: To assess the effect of Dexmedetomidine infusion on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess side effects. Materials and methods: Prospective study was done under the for a period of 11 months. In 80 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named B and BD using computer generated randomization. The enrolled patients were divided into 2 groups each 40 patients to receive either 0.5 µg/kg dexmedetomidine intravenous bolus over 10 min (Group BD) or saline infusion (Group B) prior to subarachnoid block with 0.5% hyperbaric bupivacaine 12.5 mg Results: Numerical pain rating scale scores were significantly lower in group BD. Total analgesic requirement was significantly less in group BD. Time to request for first analgesic dose was longer in group BD as compared to group B. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with spinal bupivacaine. Hemodynamic parameters and incidence of side effects were similar in both the groups. Conclusion: Premedication with single dose of intravenous dexmedetomidine 0.5 µg/kg prior to subarachnoid blockade with 0.5% hyperbaric bupivacaine hastens the onset and increases duration of sensory and motor block, with maintenance of stable hemodynamics and arousable sedation in Inguinal Herniorrhaphies.

Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery: a randomized, double-blind, placebo-controlled trial

BackgroundPostoperative pain after pediatric cardiac surgery is usually treated with intravenous opioids. Recently, the focus has been on postoperative regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks...

The effect of routine intraoperative tranexamic acid in elective cesarean section

Objective: To find the role of routine intraoperative tranexamic acid infusion at elective cesarean section.Study Design: Randomized case control studyStudy Setting: AlKarkh Maternity Hospital, Baghdad Iraq.Methodology: A total of 110 term pregnant women presenting in to our obstetric unit during the period between May, 2019 and January, 2020 and who were offered elective cesarean section, were randomly assigned to either receiving intraoperative tranexamic acid 1 gram in 100 milliliter saline infusion or saline infusion. Demographic characteristics were collected for all participants. Ten cases (1 in the tranexamic and 9 in the control group) were excluded as there were associated extensions of uterine incision in order to reduce confounders. A comparison of the outcomes of the two groups was done, it included an intraoperative blood loss determinator, a postoperative blood loss determinator, and an overall loss risk assessment. The corresponding parameters were the intraoperative surgical soaked packs count, average reduction in packed red blood cell volume 24 hour postoperatively, occurrance of postpartum hemorrhage and the overall need to receive blood transfusion. In term of associated side effects of receiving tranexamic acid, we sought whether there was any significant change in the blood pressure as well as the incidence of developing fever. Exclusion criterias were the contraindication to receive tranexamic acid assessed by referral to internist physician specialist review.Results: Confounding factors including patient’s age, parity and gestation length were taken into consideration and found to be similar between the two groups studied. There was a significant difference between the postpartum decline of packed red blood cell volume (PCV) (pvalue 0.001), with mean postpartum PCV in tranexamic group 35.2% versus 33.3% in the saline infusion group. 21.9% of women in the control group had decline of PCV exceeding 10% of preoperative value, versus only 3.3% in studied group. We found that the number of cesareans where additional packs got required was significantly less in tranexamic group (15.3% vs.22%, p=0.001), no cases in the tranexamic group did receive a blood transfusion vs. 7.3% in the saline group (pvalue 0.03).Slightly higher incidence of hypotensive episodes in the tranexamic group (27.1% vs. 12.2%, pvalue 0.07).Fever was found to be more likely following cesarean in the control group (34.1% vs. 18.6%, pvalue 0.06).Conclusion: The use of tranexamic infusion with inducton of anaesthesia at time of elective cesarean section is associated with less risk of intraoperative blood loss improving postoperative packed red blood cell volume decline significantly.

Intravesical Infusion of Budesonide Foam Improves Symptoms in a Bladder Pain Syndrome/Interstitial Cystitis Rat Model

Purpose: Since intravesically administered steroid therapy may treat bladder pain syndrome/interstitial cystitis (BPS/IC) with fewer side effects than the current treatment of orally administered steroids, we investigated whether the intravesical infusion of budesonide foam can effectively treat BPS/IC symptoms in a rat model of tranilast-induced BPS/IC. Methods: There were 6 rat treatment groups (n = 8 per group): control + single or daily saline infusion, tranilast + single or daily saline infusion, and tranilast + single or daily budesonide infusion. All groups except for the controls were fed a tranilast supplemented diet for 5 weeks. Budesonide and saline were infused intravesically. After the BPS/IC rat model underwent single infusion treatments, we measured the paw pain threshold using the von Frey test and continuous cystometry was taken. After two weeks of daily intravesical infusions, we measured locomotor activity and serum cortisol levels; harvested bladders underwent histological analysis. Results: Both pain threshold and locomotor activity were significantly lower in the saline-infused groups receiving the tranilast diet, but there were no differences between the budesonide-infused groups and the controls. The interval between bladder contractions was significantly shorter in the tranilast group than the control or tranilast + budesonide infusion groups. The serum cortisol levels did not change. Hematoxylin-Eosin stainings of the bladder showed thickening of the bladder muscle layer and mucosal edema in the tranilast group, while the tranilast + budesonide infusion group showed only mild changes. Conclusion: Intravesical infusion of budesonide effectively treated BPS/IC symptoms in a rat model of BPS/IC.

Dexmedetomidine as an adjunct in laparoscopic surgery along with entropy as a tool to measure the anaesthetic depth

Introduction: Dexmedetomidine is a drug that can be used for various anaesthetic indications such as an adjuvant for general anaesthesia and regional blocks, in premedication, as a hypnotic and analgesic postoperatively. Aim: To study the effect of dexmedetomidine as an adjuvant in anaesthesia for laparoscopic surgery using entropy as an instrument to monitor the anaesthetic depth. Methods and materials: Sixty patients were enrolled for the study, thirty receiving dexmedetomidine infusion (group 1) and thirty receiving saline infusion (group 2). Prior to induction, an entropy sensor was positioned as per manufacturer’s recommendation. Patients received a loading dose of given drug, either dexmedetomidine or saline, followed by an infusion for maintenance. All patients were given general anaesthesia with propofol and fentanyl. The given drug infusion was continued until extubation. Results: Mean systolic and diastolic blood pressure during extubation showed 5% and 8.5% increase respectively from baseline in the dexmedetomidine group (p>0.050) as compared to 19% and 15% increase respectively in the saline group which was significant (p Conclusion: Dexmedetomidine is an effectual anaesthetic adjunct that can be used in laparoscopic surgeries with an excellent recovery profile and provides adequate depth of anaesthesia.

Clinical Assessment of Intravenous Endothelial Progenitor Cell Transplantation in Dogs

Endothelial progenitor cells (EPCs) have been applied for cell therapy because of their roles in angiogenesis and neovascularization in ischemic tissue. However, adverse responses caused by EPC therapy have not been fully investigated. In this study, a human peripheral blood sample was collected from a healthy donor and peripheral blood mononuclear cells were separated using Ficoll-Hypaque. There were four experimental groups: 10 ml saline infusion group (injection rate; 3 ml/min), 10 ml saline bolus group (injection rate; 60 ml/min), 10 ml EPCs infusion group (2 x 105 cells/ml, injection rate; 3 ml/min), 10 ml EPCs bolus group (2 × 105 cells/ml, injection rate; 60 ml/min). Clinical assessment included physical examination and laboratory examination for intravenous human EPC transplantation in dogs. The results revealed no remarkable findings in vital signs among the dogs used. In blood analysis, platelet counts in saline infusion groups were significantly higher than in the EPC groups within normal ranges, and no significant differences were observed except K+, Cl– and blood urea nitrogen/urea. In ELISA assay, no significant difference was observed in serum tumor necrosis factor alpha. The serum concentration of vascular endothelial growth factor was significantly higher in EPC groups than in saline groups, and interleukin 10 was significantly up-regulated in the EPC infusion group compared with other groups. In conclusion, we demonstrated that no clinical abnormalities were detected after intravenous transplantation of human EPCs in dogs. The transplanted xenogenic EPCs might be involved in anti-inflammatory and angiogenic functions in dogs.

In Vitro Bovine Liver Experiment of Cisplatin-Infused and Normal Saline-Infused Radiofrequency Ablation with an Internally Cooled Perfusion Electrode

To evaluate the efficacy of cisplatin-infused and normal saline-infused radiofrequency ablation (RFA) with internally cooled perfusion (ICP) electrode. Using a 200W generator, thirty ablation zones were created and divided into three groups of 10 each as follows: group A, RFA alone with 16 gauge monopolar internally cooled (IC) electrode; group B, cisplatin-infused RFA with 16 gauge ICP electrode; and group C, normal saline-infused RFA with 16 gauge ICP electrode. Radiofrequency was applied to the explanted bovine liver for 12min. During RFA, cisplatin and normal saline were injected into tissue at a rate of 0.5mL/min through the ICP electrode by injection pump. Dimensions of the ablation zone and technical parameters were compared between the three groups. In the cisplatin-infused RFA group, the ablation zone size was significantly larger than that of the RFA-alone group but significantly smaller than normal saline-infused RFA group. The width of longitudinal section and volume were 3.39 ± 0.22cm2 and 26.55 ± 4.62cm3 in RFA-alone group, 3.88 ± 0.32cm2 and 36.45 ± 5.46cm3 in cisplatin-infused RFA group, and 4.52 ± 0.50cm2 and 49.44 ± 7.55cm3 in normal saline-infused RFA group, respectively (p < 0.05 between any two groups). The mean impedance in group A, B, and C were 60.0 ± 7.2, 50.3 ± 2.5, and 40.3 ± 4.0 Ω, respectively (p < 0.05 between any two groups). Cisplatin-infused RFA with ICP electrode created the larger size of ablation zone than that of monopolar RFA with an IC electrode, but created the smaller size of ablation zone than that of normal saline-infused RFA.

Intracerebroventricular infusion of D-serine decreases nociceptive behaviors induced by electrical stimulation of the dura mater of rat

ABSTRACTObjective and method: D-serine acts as an obligatory ligand for the glycine sites of N-methyl-D-aspartate receptors. To investigate its effect on head-facial pain, nociceptive behaviors of rats induced by electrical stimulation of the dura mater were observed after cerebroventricular infusion of D-serine.Results: Rats in the D-serine infusion group showed significantly fewer nociceptive behaviors, including grooming and head flicking, than rats in the saline infusion group and control rats.Conclusions: This is the first study to introduce D-serine to a trigeminovascular headache model that demonstrates an antinociceptive-like effect in rats.

Cognitive function of patients with treatment-resistant depression after a single low dose of ketamine infusion

BackgroundClinical and animal studies have reported conflicting results regarding the effect of ketamine on cognitive function, although increasing evidence supports a rapid and sustained antidepressant effect of a subanesthetic dose of ketamine infusion for patients with treatment-resistant depression (TRD). However, the cognitive function before and after ketamine infusion was rarely investigated in patients with TRD. MethodsA total of 71 adult patients with TRD were enrolled and randomized to 0.5-mg/kg ketamine, 0.2-mg/kg ketamine, or normal saline infusion groups. Depressive symptoms were measured using the Hamilton Depression Rating Scale at baseline and at different time points post ketamine infusion. Cognitive function was evaluated using working memory and go/no-go tasks at baseline, Day 3, and Day 14 post ketamine infusion. ResultsA single low dose of ketamine infusion did not impair the cognitive function of patients with TRD. The paired t test revealed that patients with TRD receiving 0.5 mg/kg of ketamine infusion exhibited a slight improvement in sustained attention and response control measured using the go/no-go task at Day 14 post ketamine infusion. A significant association was also observed between depressive symptoms and cognitive function changes at Day 3 in the 0.5-mg/kg ketamine infusion group. DiscussionA 0.5 mg/kg dose of ketamine infusion was not harmful, but slightly beneficial, for the cognitive function of patients with TRD. Additional studies are necessary to elucidate the effects of repeated ketamine infusion on cognitive function.

Sodium Nitroprusside Enhanced CPR and intra-CPR Hypothermia

<span style=font-size:11.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1. Abstract <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.1. <span lang=FR style=font-size:10.0pt; font-family: times= new= roman,serif;mso-ansi-language:fr=>Objective : Therapeutic Hypothermia (TH) is thought to improve neurologically intact survival when applied after Return of Spontaneous Circulation (ROSC) is achieved in patients who suffer a cardiac arrest. Intra-CPR cooling may accelerate the time to reach TH and thus enhance its neurological benefit. Sodium Nitroprusside Enhanced Cardiopulmonary Resuscitation (SNPeCPR) has been shown to accelerate intra-CPR cooling compared to standard CPR. The aim of this study is to assess which method of therapeutic hypothermia is the most efficient in decreasing brain temperature during SNPeCPR. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.2. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Methods: <span style=font-size:10.0pt; font-family: times= new= roman,serif=>This study included 24 intubated and anesthetized swine. After induction of Ventricular Fibrillation (VF), animals were randomized to one of the following groups: 500cc cold saline infusion (group A), 500cc cold saline infusion plus surface cooling with ice packs (group B), surface cooling only (group C) or control/no cooling method applied (group D). After 10 minutes of VF, CPR was initiated. One minute after the initiation of CPR, the randomized intervention was initiated and abdominal binding was applied. SNP (2 mg) was administered at minutes 1, 4 and 8. Animals were defibrillated at minute10. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman;color:black;= mso-themecolor:text1=>1.3. Results: Within 4 minutes of CPR, animals that received intravenous cold saline (Group A and Group B) had decreased their brain temperature by 0.5 <span style=font-size:10.0pt; font-family: times= new= roman,serif;color:red;mso-ansi-language:pt=> ° C lower compared to the groups that had not (Group C and Group D). Group B presented a superior heat exchange rate from blood to skin compared to group A. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.4. <span lang=FR style=font-size:10.0pt; font-family: times= new= roman,serif;mso-ansi-language:fr=>Conclusion : It was observed that cold saline infusion during SNPeCPR accelerates cooling of the brain. Ice packs work synergistically by optimizing heat transfer from the blood to the skin. Further studies will assess the potential neurologic benefit of the combination of SNPeCPR with intra-CPR infusion of cold saline. <span style=font-size:11.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>2. Keywords: Cardiac Arrest; Cardiopulmonary Resuscitation; Therapeutic Hypothermia

Abstract 114: Smooth Muscle Origin-specific Effects of LRP1 Deletion on Angiotensin II-induced Ascending Aortic Aneurysm

Objective: Low-density lipoprotein receptor-related protein 1 (LRP1) plays a critical role in maintaining aortic wall integrity. LRP1 deletion in smooth muscle cells (SMCs) augments angiotensin II (AngII)-induced ascending aortic aneurysms. SMCs in the ascending aorta originate from both the second heart field (SHF) and cardiac neural crest (CNC). The purpose of this study was to determine whether LRP1 depletion in these two SMC origins has differential effects on AngII-induced ascending aortic aneurysm. Methods and Results: Mef2c-Cre was used to delete LRP1 in SMCs of SHF origin; while Wnt-1-Cre was utilized to delete LRP1 in SMCs of CNC origin in mice. Saline or AngII (1,000 ng/kg/min) was infused for 28 days into 12 - 14 week-old male mice with LRP1 depletion in either SHF or CNC origin as well as their wild type littermates. No mice died in saline-infused groups of either genotype. In the AngII-infused mouse group, LRP1 depletion in SMCs of SHF origin led to 38% death due to ascending aortic rupture, compared to a 4% rupture rate in wild type littermates (p = 0.002). In the survivors of AngII-infused group, LRP1 deletion in SMCs of SHF origin resulted in larger ascending aortic diameter compared to wild type littermates (1.6 ± 0.1 vs 2.0 ± 0.1 mm, p &lt; 0.05), as measured by ultrasonography. In contrast to the increases of aortic rupture and luminal dilation in mice with LRP1 depletion in SMCs of SHF origin, LRP1 deletion in SMCs of CNC origin did not affect AngII-induced aortic rupture rate or luminal dilation, compared to wild type littermates. To explore potential signaling mechanisms on how LRP1 depletion in SMCs of SHF origin augments AngII-induced ascending aortic aneurysm, mice were infused with either saline or AngII for 24 hours, and ascending aortic tissues were harvested for Western blot analyses. Aortic LRP1 protein abundance was decreased in mice with LRP1 depletion in SMCs of SHF origin regardless of infusion. Although SMAD2 and ERK signaling contribute to aortic wall integrity, this short interval of AngII infusion did not change these activities in the aorta of SHF-SMC specific LRP1 deleted mice. Conclusion: LRP1 expression in SHF, but not in CNC, -derived SMCs exerts a critical role in the augmentation of AngII-induced ascending aortic aneurysm.

Dexmedetomidine infusion as an analgesic adjuvant during laparoscopic \u0441holecystectomy: a randomized controlled study

BackgroundDexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC).MethodsA randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017. Adult patients (18–79 years) with American Society of Anesthesiology (ASA) physical status I–II were randomly assigned to 0.5 μg/kg/h DEX infusion from induction of anaesthesia to extubation (Group D; n = 30) or normal saline infusion (Group C; n = 30). The primary efficacy outcomes were postoperative morphine consumption. Secondary efficacy outcomes included: time to first use of rescue analgesia; postoperative morphine consumption; intraoperative fentanyl consumption; time from end of surgery to extubation; lengths of intensive care unit (ICU) and general ward stay; degree of postoperative pain 3, 6, 12 and 24 h after surgery; incidence of persistent post-surgical pain.ResultsDEX infusion was associated with a decrease in postoperative morphine consumption (p = 0.001), lower incidence of severe postoperative pain (odds ratio [OR] 9, 95% confidence interval [CI] 1.1–77, p = 0.04) and significantly longer time to first use of rescue analgesia (p = 0.001). Group D also had significantly lower fentanyl consumption both intraoperatively (p = 0.001) and in the time from end of surgery to extubation (p = 0.001) plus decreased incidence of persistent post-surgical pain (OR 14.5, 95% CI 1.7–122, p = 0.005). The incidence of postoperative nausea and vomiting was lower in Group D than Group C (OR 5, 95% CI 1.1–26, p = 0.005). Median pain intensity did not differ between the groups 3, 6, 12 or 24 h after surgery and there were no inter-group differences in the lengths of ICU stay or overall hospital stay between groups. The incidence of hypertension was significantly higher in Group C (OR 13.8, 95% CI 4–48, p < 0.0001); there were no inter-group differences in incidences of hypotension and bradycardia.ConclusionsIntraoperative DEX infusion is safe and effective for improving analgesia during and after elective LC. DEX appears to significantly reduce the number of patients with severe postoperative pain, postoperative morphine consumption and prolong time to first use of rescue analgesia.Trial registrationClinicalTrials.gov: Retrospectively registered on July 7, 2017, NCT03211871.

Abstract No. 685 In vitro bovine liver experiment of cisplatin-infused and normal saline-infused radiofrequency ablation with an internally cooled perfusion electrode

Cisplatin is an effective agent for the treatment of many malignant tumors and is mainly administered through intraarterial or intravenous route. Internally cooled perfusion electrode allows interstitial solution infusion during radiofrequency ablation (RFA). Purpose of this study was to evaluate the influence of cisplatin-infused and normal saline-infused radiofrequency ablation with internally cooled perfusion electrode on the size of ablated lesions. Using a 200W generator, thirty ablation zones were divided into three groups of 10 each and created as follows: group A, RFA alone with 16 gauge monopolar internally cooled electrode; group B, cisplatin-infused RFA with 16 gauge internally cooled perfusion electrode; and group C, normal saline-infused RFA with 16 gauge internally cooled perfusion electrode. RF was applied to the explanted bovine liver for 12 minutes. During RFA, cisplatin and normal saline were injected into tissue at a rate of 0.5 mL/min through the internally cooled perfusion electrode by injection pump. Dimensions of the ablation zone and technical parameters were compared between the three groups. In the cisplatin-infused RFA group, the ablation zone size was significantly larger than that of the RFA alone group but significantly smaller than normal saline-infused RFA group. The width of longitudinal section and volume were 3.39 ± 0.22 cm2 and 26.55 ± 4.62 cm3 in RFA alone group, 3.88 ± 0.32 cm2 and 36.45 ± 5.46 cm3 in cisplatin-infused RFA group, and 4.52 ± 0.50 cm2 and 49.44 ± 7.55 cm3 in normal saline-infused RFA group, respectively (p<0.05 between any two groups). The mean impedance in group A, B, and C were 60.0 ± 7.2, 50.3 ± 2.5, and 40.3 ± 4.0 Ω, respectively (p<0.05 between any two groups). Cisplatin-infused RFA with internally cooled perfusion electrode created the larger size of ablation zone than that of monopolar RFA with an internally cooled electrode, but created the smaller size of ablation zone than that of normal saline-infused RFA.