Effects of Inhalation Anesthetics on the Profile of Urinary Neopterin as an Immune Marker in Patients who Underwent Laparoscopic Cholecystectomy

Abstract It has been claimed that inhalational anesthetics affect many phases of immune response. Although, there are a lot of studies on the effects of widely used anaesthetic agents and methods on the immune system, there are only a few studies to show the effects by evaluation of neopterin concentrations as an important marker of cellular immunity. This study was done to evaluate possible effects of inhalation anesthetics, such as desflurane, isoflurane, and sevoflurane on the immune system by measuring urinary neopterin concentrations in patients who underwent laparoscopic cholecystectomy. The study is randomized, prospective and double blind. Urinary neopterin was measured in patients submitted to general anesthesia with either desflurane (n = 20) or isoflurane (n = 11), or sevoflurane (n = 13) in laparoscopic cholecystectomy. Urine samples were collected preoperatively, at 2nd and 24th hours post-operatively and the neopterin per creatinine concentrations were measured by using high-performance liquid chromatography.The preoperative neopterin levels were similar across the study groups. Variance analysis of repeated measures showed an effect of time (p <0.05): Neopterin concentrations increased over time, but the effect of different anesthetics on neopterin was similar. The mean increases in neopterin concentrations were similar among all the applied anesthetics. In conclusion, this report shows changes of immune response by investigation of neopterin in urine samples during 24 hours in patients exposed to three different inhalational anesthetic agents sevoflurane, desflurane and isoflurane in laparoscopic cholecystectomy.

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Evaluating the Effect of Intraoperative Dextrose 10% Administration on Reducing Postoperative Nausea and Vomiting after Laparoscopic Surgery

The Open Anesthesia Journal ◽

10.2174/2589645801913010078 ◽

2019 ◽

Vol 13 (1) ◽

pp. 78-85

Author(s):

Ashraf Nabil Saleh ◽

Dalia Fahmy Emam ◽

Mohamed Mohamed Kamal

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Study Groups ◽

Primary Objective ◽

Nausea And Vomiting ◽

Controlled Study ◽

Double Blind ◽

Female Patients ◽

Medication Consumption

Background: Although PONV is usually self-limiting or is treated without sequelae, the incidence of PONV could be as high as 70% to 80% in high-risk populations such as female sex, obese patients, age younger than 40 years, nonsmoker patients, history of PONV or motion sickness. Objectives: The study aimed to investigate whether dextrose 10% decreases the incidence of postoperative nausea and vomiting in female patients undergoing laparoscopic cholecystectomy Materials and Methods: This prospective, double-blind randomized placebo-controlled study comprised 130 ASA physical status I and II nonsmoker female patients, 20-40 years of age, scheduled for laparoscopic cholecystectomy at Ain Sham University – Assembled operating theater from August 2018 to October 2018. Patients were arbitrarily divided into two study groups of 65 patients each. Group LR received lactated Ringer’s solution and group D received 10% dextrose. The primary objective of this study was to compare the incidence of PONV in the study treatment groups. The secondary outcomes included measurement of antiemetic medication consumption as well as blood glucose changes between groups. Results: 50 from a total of 65 participants (76.9%) in Lactated Ringer (LR) group experienced nausea. On the other hand, 30 participants only (46.2%) in dextrose (D) group were nauseated. This dissimilarity was statistically highly significant (P= 0.0003). Conclusion: In this study, dextrose 10% administration resulted in improved postoperative emesis management as explained by the lower incidence of nausea and rescue antiemetic consumption.

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Assessing Early Behavioral Indicators of Tolerance in Infants Receiving Formula with Added Lactobacillus rhamnosus GG (LGG)

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_070 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 998-998

Author(s):

Fabiola Gutierrez-Orozco ◽

Cheryl Harris ◽

Jennifer Wampler ◽

Carol Lynn Berseth

Keyword(s):

Infant Formula ◽

Repeated Measures ◽

Lactobacillus Rhamnosus ◽

Study Groups ◽

Parent Report ◽

Infantile Colic ◽

Double Blind ◽

Behavioral Indicators ◽

Funding Sources ◽

Over Time

Abstract Objectives To evaluate the nutritive effects of an infant formula with added LGG on early behavioral indicators of tolerance in infants experiencing crying and fussing often associated with infantile colic. Methods In this single-center, double-blind, controlled, parallel, prospective study, infants (14 to 28 days of age) determined to cry and/or fuss ≥3 hours/day for ≥3 days/week (in a one-week period) were randomized to receive one of two formulas over a 21-day feeding period: marketed partially hydrolyzed (PH) cow's milk-based infant formula (PH: n, 35) or a similar formula with added LGG (PH-LGG: n, 36). Parents/caregivers used a validated parent-report diary to record crying/fussing and awake/content behavior at three time points: Study Days 2–4 (baseline), Days 10–12, and Days 18–20 (Study End). The primary outcome, duration (hours/day) of crying/fussing (averaged over each three-day period), was analyzed by repeated measures, mixed-effects models. Results Birth characteristics (sex, race, weight) and age (days; mean ± SE) at study entry (PH: 19.7 ± 0.8; PH-LGG: 19.3 ± 0.8) were similar for study groups. No group differences in mean study formula intake (g/day) or mean achieved weight (g) at any study time point were detected. Completion rates were similar through Day 21 (PH: n = 33, 94%; PH-LGG: n = 33, 92%). Duration of crying/fussing (mean ± SE) decreased over time with no significant differences detected in the PH vs PH-LGG group at Baseline (4.8 ± 0.3 vs 4.0 ± 0.3; P = 0.086), Days 10–12 (3.5 ± 0.3 vs 2.6 ± 0.3; P = 0.056), and Days 18–20 (2.1 ± 0.3 vs 1.5 ± 0.3; P = 0.227). Duration of awake/content behavior increased over time with no significant differences detected in PH vs PH-LGG: Baseline (1.0 ± 0.5 vs 1.2 ± 0.5; P = 0.786), Days 10–12 (1.3 ± 0.5 vs 1.6 ± 0.5; P = 0.627), and Days 18–20 (2.1 ± 0.5 vs 2.2 ± 0.5; P = 0.884). By Study End, only 8 (24%) in the PH and 9 (27%) in the PH-LGG group continued to cry and/or fuss ≥3 hours/day for ≥3 days/week. Conclusions In the present pilot study, we identified a study population of infants early in life experiencing crying and fussing often associated with infantile colic. Both study formulas were well tolerated. Crying/fussiness decreased and awake/content behavior increased in both study groups over the course of the study. Funding Sources Mead Johnson Nutrition.

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Urine and Plasma Catecholamine and Cortisol Concentrations after Myocardial Revascularization

Anesthesiology ◽

10.1097/00000542-199704000-00008 ◽

1997 ◽

Vol 86 (4) ◽

pp. 785-796 ◽

Cited By ~ 42

Author(s):

J. Jerill Plunkett ◽

John D. Reeves ◽

Long Ngo ◽

Wayne Bellows ◽

Steven L. Shafer ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Repeated Measures ◽

Bypass Graft ◽

Myocardial Revascularization ◽

Study Groups ◽

Plasma Catecholamine ◽

Bolus Administration ◽

Opioid Use ◽

Double Blind ◽

Urine Cortisol

Background Cardiopulmonary bypass is associated with substantial release of catecholamines and cortisol for 12 or more h. A technique was assessed that may mitigate the responses with continuous 12-h postoperative sedation using propofol. Methods One hundred twenty-one patients having primary elective cardiopulmonary bypass graft (CABG) surgery were enrolled in a double-blind, randomized trial and anesthetized using a standardized sufentanil-midazolam regimen. When arriving at the intensive care unit (ICU), patients were randomly assigned to either group SC (standard care), in which intermittent bolus administration of midazolam and morphine were given as required to keep patients comfortable; or group CP (continuous propofol), in which 12 h of continuous postoperative infusion of propofol was titrated to keep patients deeply sedated. Serial perioperative measurements of plasma and urine cortisol, epinephrine, norepinephrine, and dopamine were obtained; heart rate and blood pressure were recorded continuously, and medication use, including requirements for opioids and vasoactive drugs, was recorded. Repeated-measures analysis was used to assess differences between study groups for plasma catecholamine and cortisol levels at each measurement time. Results In the control state-before the initiation of postoperative sedation in the ICU-no significant differences between study groups were observed for urine or plasma catecholamine or cortisol concentrations. During the ICU study period, for the first 6-8 h, significant differences were found between study groups SC and CP in plasma cortisol (SC = 28 +/- 15 mg/dl; CP = 19 +/- 12 mg/dl; estimated mean difference [EMD] = 9 mg/dl; P = 0.0004), plasma epinephrine (SC = 132 +/- 120 micrograms/ml; CP = 77 +/- 122 micrograms/ml; EMD = 69 micrograms/ml; P = 0.009), urine cortisol (SC = 216 +/- 313 micrograms/ml; CP = 93 +/- 129 micrograms/ml; EMD = 127 micrograms/ml; P = 0.007), urine dopamine (SC = 85 +/- 48 micrograms; CP = 52 +/- 43 micrograms; EMD = 32 micrograms; P = 0.002), urine epinephrine (SC = 7 +/- 8 micrograms; CP = 4 +/- 5 micrograms; EMD = 3 micrograms; P = 0.0009), and urine norepinephrine (SC = 24 +/- 14 mg; CP = 13 +/- 9 mg; EMD = 11 mg; P = 0.0004). Reductions in urine and plasma catecholamine and cortisol concentrations found for the CP group generally persisted during the 12-h propofol infusion period and then rapidly returned toward control (SC group) values after propofol was discontinued. Postoperative opioid use was reduced in the CP group (SC = 97%; CP = 49%; P = 0.001), as was the incidence of tachycardia (SC = 79%; CP = 60%; P = 0.04) and hypertension (SC = 58%; CP = 33%; P = 0.01), but the incidence of hypotension was increased (SC = 49%; CP = 81%; P = 0.001). Conclusions Cardiopulmonary bypass graft surgery is associated with substantial increases in plasma and urine catecholamine and cortisol concentrations, which persist for 12 or more h. This hormonal response may be mitigated by a technique of intensive continuous 12-h postoperative sedation with propofol, which is associated with a decrease in tachycardia and hypertension and an increase in hypotension.

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Preoperative Multimodal Analgesia for Laparoscopic Cholecystectomy

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0041 ◽

2018 ◽

pp. 217-222

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Study Groups ◽

Multimodal Analgesia ◽

Double Blind Study ◽

Double Blind ◽

Same Day Discharge ◽

Elective Laparoscopic Cholecystectomy ◽

American Society ◽

American Society Of Anesthesiologists

This case focuses on the use of local anesthesia, nonsteroidal anti-inflammatory or opioid drugs, for laparoscopic cholecystectomy by asking the question: Does prophylactic multimodal nociceptive blockade delay the onset of postoperative pain, decrease analgesic requirements, speed recovery, and facilitate same-day discharge in patients undergoing elective laparoscopic cholecystectomy? In this randomized, double-blind study, intraoperative anesthetic care and postoperative pain and nausea management were standardized for all patients. Study groups were similar in terms of patient age, gender, weight, American Society of Anesthesiologists class, baseline and preinduction pain and nausea scores, duration of surgery, and total dose of propofol received. This study demonstrated the benefit of preoperative multimodal analgesia on recovery and discharge.

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Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

Pain Research and Management ◽

10.1155/2017/4260702 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Massimo Allegri ◽

Martina Ornaghi ◽

Catherine E. Ferland ◽

Dario Bugada ◽

Yash Meghani ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

High Performance ◽

Controlled Trial ◽

Plasma Concentrations ◽

Analgesic Efficacy ◽

Postoperative Nausea And Vomiting ◽

Dose Finding ◽

Morphine Consumption ◽

Double Blind ◽

Postoperative Morphine

Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P>0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

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The effect of Reiki on blood hypertension

Acta Paulista de Enfermagem ◽

10.1590/1982-0194201400078 ◽

2014 ◽

Vol 27 (5) ◽

pp. 479-484 ◽

Cited By ~ 3

Author(s):

Léia Fortes Salles ◽

Luciana Vannucci ◽

Amanda Salles ◽

Maria Júlia Paes da Silva

Keyword(s):

Blood Pressure ◽

Repeated Measures ◽

Study Groups ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Anova Model ◽

Significant Difference ◽

Before And After ◽

Experimental Group

Objective Determining the immediate effect of Reiki on abnormal blood pressure. Methods An experimental, double-blind study, in which were included 66 hypertensive patients, randomized to the three following study groups: control, placebo and experimental. The intervention lasted 20 minutes, the control group remained at rest, the placebo group received an imitation of the studied technique (mock Reiki) and the experimental group received the Reiki technique. Blood pressure was measured before and after the intervention by the same person with the same instrument. Results There was a decrease in blood pressure in the three groups and the reduction was greater in the experimental group, followed by the placebo and the control group. The ANOVA model for repeated measures showed a statistically significant difference among the groups (p <0.0001). Conclusion Reiki had a positive effect on reducing abnormal blood pressure, suggesting to be a complementary technique for the control of hypertension.

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Evaluation of Changes in Immune System of Operating Room Personnel by Measurement of Urinary Neopterin Concentrations

Pteridines ◽

10.1515/pteridines.2011.22.1.13 ◽

2011 ◽

Vol 22 (1) ◽

pp. 13-17 ◽

Cited By ~ 5

Author(s):

Mustafa Baydar ◽

Zeynep Capan ◽

Gozde Girgin ◽

Terken Baydar ◽

Gonul Sahin

Keyword(s):

Immune System ◽

Operating Room ◽

High Performance ◽

Smoking Status ◽

Diagnostic Value ◽

Operating Room Personnel ◽

Macrophage Activity ◽

Diagnosis And Prognosis ◽

Urinary Neopterin ◽

Anesthetic Exposure

Abstract Today it is known that neopterin is mainly produced by activated macrophages and a marker of immune activation and macrophage activity. Increased neopterin concentrations are observed in diseases related to cellular immunity including occupational pathologies.The major goal of the present study was to evaluate the possible alteration of neopterin levels in operating room personnel, and also to show whether screening of neopterin may be useful to monitor the effect of occupational anesthetic exposure on the cellular immune system.Therefore, urinary neopterin to creatinine levels in both, exposed workers (n = 40) and healthy volunteers (n = 30), were measured by using high-performance liquid chromatography. At the same time, the correlation among urinary neopterin levels and working years, age, and smoking status were evaluated.Compared to controls, urinary neopterin levels in the exposed group were increased (controls: 85 ± 16 μmol/mol creatinine, workers: 151 ± 39 μmol/mol creatinine; p <0.05).The findings suggest that the follow up of neopterin levels may have diagnostic value in possible occupational exposure-related immune system disorders. Moreover, its biological monitoring should be performed in workplaces for clinical diagnosis and prognosis.

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Blocking tubules technologies for dentin hypersensitivity in periodontal patients – pilot study

Research Society and Development ◽

10.33448/rsd-v10i13.20398 ◽

2021 ◽

Vol 10 (13) ◽

pp. e35101320398

Author(s):

Mariana Schutzer Ragghianti Zangrando ◽

Giovanna Fernanda Favero Silva ◽

Maria Laura Bignotto Bigotto ◽

Flávia Maria Ravagnani Neves Cintra ◽

Carla Andreotti Damante ◽

...

Keyword(s):

Repeated Measures ◽

Study Groups ◽

Root Surface ◽

Potassium Citrate ◽

Dentin Hypersensitivity ◽

Scaling And Root Planing ◽

Double Blind ◽

Specific Chemical ◽

Tukey Test ◽

Before And After

Periodontal patients often report dentin hypersensitivity (DH) caused by root surface exposure or periodontal treatment. Tubular blocking technologies in toothpastes are effective for pain relief, but no specific chemical/physical agent has been reported for periodontal patients. This double-blind randomized clinical trial compared the effects of three technologies in reducing DH in periodontal patients. Eighteen (18) participants were randomly assigned into three groups: SEN (NOVAMIN technology); REG (REFIX technology); REGK (REFIX technology + potassium citrate). Periodontal patients presenting with DH were evaluated at 6 moments: T1 and T2 - immediately before and after scaling and root planing procedures (SRP); T3 - after polishing sensitive areas with their assigned dentifrice and T4, T5, T6 - after 2, 4 and 8 weeks of SRP respectively. Sensitivity was assessed by air blast (Schiff scale) and patients’ perceptions using the visual analogue scale (VAS). Data were analyzed by two-way repeated measures ANOVA complemented by the Tukey test with significance set at 5% (p <0.05). Preliminary outcomes revealed SEN, REG and REGP reduced DH in periodontal patients (n=18). All patients initially presented moderate to severe pain (64.3) and after treatment they reported mild pain (21.3). Similarly, the dentist evaluation showed significant reduction in DH with the use of the three technologies (2.26 to 0.56). No statistically significant differences were found between the three study groups for patients (p=0.751) and dentist evaluations (p=0.632). According to these preliminary outcomes, all three technologies equally reduced DH in periodontal patients. Clinical trials #NCT04422184

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DYNAMICS OF SECRETION OF PROSTAGLANDINS E2 AND D2 WITH DIBOTHRIOCHEPHALLUS DENDRITICUS (CESTODA) PLEROCERCOIDS IN RESPONSE TO EXPOSURE OF BLOOD SERUM OF BAIKAL CISCO, THE HOST

10.31016/978-5-9902341-5-4.2020.21.180-186 ◽

2020 ◽

pp. 180-186

Author(s):

Kutyrev ◽

Olennikov ◽

Kaschenko ◽

Mazur

Keyword(s):

Immune Response ◽

High Performance Liquid Chromatography ◽

Liquid Chromatography ◽

Immune System ◽

Blood Serum ◽

High Performance ◽

Body Cavity ◽

Physiological Solution ◽

Prostaglandin D2 ◽

High Concentrations

Parasites regulate host immune response via secretion of soluble mediators which interact in a certain way with cells and molecules of the immune system. The aim of the study was to determine changes of prostaglandins E2 и D2 content in Dibothriochephallus dendriticus plerocercoids and also in the incubation media during incubation of tapeworms with addition of blood serum from the intermediate host – Baikal cisco. D. dendriticus plerocercoids were retrieved from the host body cavity, ashed in the physiological solution and placed in incubation media. Microcolumn high-performance liquid chromatography was used to detect prostaglandins. Concentration of prostaglandins in the plerocercoid organism increased insignificantly after incubation in the Hanks’ solution with addition of blood serum, when compared with incubation in the Hanks’ solution only. Concentration of prostaglandin E2 increased significantly in the incubation media after incubation of plerocercoids in the Hanks’ solution with addition of blood serum. Prostaglandin D2 was also identified in high concentrations after 12 h and 24 h of incubation, whereas prostaglandin D2 was not quite detected during incubation in Hanks’ solution only.

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