scholarly journals Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review

2020 ◽  
Vol 24 (6) ◽  
Author(s):  
Dmytriiev Dmytro ◽  
Nazarchuk Oleksandr ◽  
Dmytriiev Kostiantyn ◽  
Lysak Evgenii ◽  
Zaletska Olesya
Keyword(s):  
Local Anesthetics ◽  
Sensory Block ◽  
Narrative Review ◽  
Regional Analgesia ◽  
Effect Duration ◽  
The Difference ◽  
Time To Onset ◽  
Crucial Part ◽  
Better Than ◽  
The Ideal

Introduction: The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics for neuraxial and regional analgesia in order to determine the adjuvant with the best effect among all others. More precisely to consider the time to onset, the strength of the effect, duration of the motor and sensory block and some additional effects such as ‘marker of intravascular injection’, safety and toxicity profile. We aimed to find an ideal adjuvant which has all these properties to a good degree. Methodology: For this narrative review we searched the information in Medline, PubMed, Scopus, and Embase databases. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this review. Results: Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All of them try to find the “ideal” adjuvant, having sufficient necessary effects, but we think that due to the difference in various classes of adjuvants, some may be better than others. However, use of combination of adjuvants is not desirable at all times. Conclusion: A variety of adjuvants to local anesthetics are available now, yet the data about most of them remains inconclusive, so more studies are required to found out the best adjuvants with the most desirable profile and the least adverse effects Key words: Local anesthetic; Adjuvants; Pain management; Regional anesthesia. Citation: Dmytro D, Oleksandr N, Kostiantyn D, Evgenii L, Olesya Z. Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review. Anaesth. pain intensive care 2020;24(6):---; DOI: 10.35975/apic.v24i6.1209 Received: 24 March 2020, Reviewed: 23 April, 25 June 2020, Revised: 18 October 2020, Accepted: 27 October 2020

scholarly journals A way to improve neuro regional analgesia: what adjuvant is the best? A narrative review.

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Dmytro Dmytriiev ◽  
Oleksandr Nazarchuk ◽  
Kostiantyn Dmytriiev ◽  
Evgenii Lysak ◽  
Olesya Zaletska
Keyword(s):  
Local Anesthetics ◽  
Toxicity Profile ◽  
Intravascular Injection ◽  
Regional Analgesia ◽  
Sufficient Degree ◽  
Effect Duration ◽  
Safety And Toxicity ◽  
Crucial Part ◽  
Injection Safety ◽  
Better Than

Introduction. The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics in order to determine adjuvant with the best effect among all others. More precisely the time of action onset, depth of the effect, duration of the block and some additional effects such as “marker of intravascular injection”, safety and toxicity profile, along with the adjuvant, which have all these properties in a sufficient degree. Materials and methods. We searched for information in Medline, PubMed, Scopus, Embase. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this article. Results. Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All them try to find to find “ideal” adjuvant, that have all needed effects at sufficient degree, but we think that due to the different groups that adjuvants belong to some adjuvants are better than another. Combination of adjuvants is not positive at all times. Conclusion. A variety of adjuvants to local anesthetics are available now, but yet data about most of them remains controversial, so more studies are required to found out best adjuvants and their adverse effects

Combined hepatocellular carcinoma and cholangiocarcinoma: Debate for the ideal surgical option.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15644-e15644
Author(s):  
Hardik Satish Chhatrala ◽  
Chintan Shah ◽  
Karthik Kailasam ◽  
Lokesh Yadav ◽  
Sreenivasa Rao Chandana
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Benefit ◽  
Total Period ◽  
Transplant Patients ◽  
Kaplan Meier ◽  
Surgical Options ◽  
The Difference ◽  
Better Than ◽  
The Ideal

e15644 Background: Current limited evidence from observational studies suggest lack of survival benefit from liver transplantation (LT) for combined hepatocellular carcinoma with cholangiocarcinoma (cHCC-CC) when compared to surgical resection. This is in contrast to hepatocellular carcinoma (HCC) which has clear survival benefit with LT. We hypothesized that cHCC–CC patients have similar overall survival (OS) after LT compared to resection. Methods: Localized HCC and cHCC–CC patients treated with surgical resection versus transplant were identified in SEER Database (1973–2013). Kaplan-Meier method was used to examine survival with LT versus resection. Results: In the total period between 1973-2013, we identified 9,306 (5496 [59.06%] resection, 3810 [40.94%] transplant) patients with HCC, and 175 (107 [61.14%] resection, 68 [38.85%] transplant) patients with cHCC–CC. 3-year OS of patients undergoing LT remains significantly greater for HCC than for cHCC–CC (80.5% vs 59.9%, P < 0.01). Interesting, for period 2008-13, 3-yr OS for cHCC-CC patients undergoing LT was better than resection, although the difference was not statistically significant (66.4% vs 46.27%, p > 0.10). While there has been improved 3-year and 5-year OS from period 2002-07 to 2008-13 after LT for localized HCC patients (83.6% vs 79.4%, p < 0.002 and 76.4% vs 73.6, p < 0.01, respectively), there has been no significant improvement in 3-year or 5-year survival after for HCC-CC (66.4% vs 65.2%, p < 0.4 and 58.3% vs 55.3%, p > 0.4 respectively). Conclusions: Over the past decade, 3-yr OS of cHCC-CC with LT remains dismal and has not improved. However, LT in patients with localized cHCC–CC may have a potential survival benefit over liver resection, although clearly lower than the survival benefit of LT for HCC. Our results argue for a randomized trial for LT versus resection for localized cHCC-CC patients to obtain better understanding of survival benefit from the two surgical options.

scholarly journals A comparative study of serotonin and norepinephrine as adjuncts to improve cutaneous antinociception of mexiletine in response to skin pinpricks in rats

2021 ◽  
Vol 35 ◽  
pp. 205873842110161
Author(s):  
Mingming Han ◽  
Fang Kang ◽  
Chengwei Yang ◽  
Mingyu Zhai ◽  
Kesong Zheng ◽  
...  
Keyword(s):  
Comparative Study ◽  
Local Anesthetics ◽  
Subcutaneous Injection ◽  
Sensory Block ◽  
Subcutaneous Injections ◽  
Injection Dose ◽  
The Difference

As adrenaline, serotonin and norepinephrine are two other vasoconstrictors and both of which have been proved to increase the quality and duration of local anesthetics when added as adjuvants. However, the difference in the improvement of the nociception of local anesthetics between the two adjuvants remains unclear. The purpose of this study was to assess the cutaneous nociception of mexiletine by coadministration with serotonin and norepinephrine. Subcutaneous injection of drugs or combinations includes mexiletine 0.6, 1.8, 6.0 μmol, serotonin 1.6500 μmol, noradrenaline 0.8895 nmol, saline, mexiletine 1.8 and 6.0 μmol, respectively combined with serotonin 0.4125, 0.8250, 1.6500 μmol and noradrenaline 0.0356, 0.1779, 0.8895 nmol, with each injection dose of 0.6 ml. The nociception of mexiletine alone and mexiletine coadministered with serotonin and norepinephrine was assessed after subcutaneous injection. Subcutaneous injections of mexiletine elicited dose-related cutaneous antinociception ( P < 0.05, 0.01, or 0.001). Compared with mexiletine (1.8 μmol), adding norepinephrine (except for lowest dose) and serotonin to mexiletine (1.8 μmol) solutions for skin nociceptive block potentiated and prolonged the action ( P < 0.01 or 0.001). Mexiletine (6.0 μmol) combined with norepinephrine and serotonin extended the duration of cutaneous antinociception when compared with mexiletine (6.0 μmol) alone ( P < 0.05, 0.01, or 0.001). Both serotonin and norepinephrine improve the sensory block and enhances the nociceptive block duration of mexiletine, and serotonin is superior to that of norepinephrine.

Comparison of Adrenaline and Dexmedetomidine in Improving the Cutaneous Analgesia of Mexiletine in Response to Skin Pinpricks in Rats

Pharmacology ◽  
2020 ◽  
Vol 105 (11-12) ◽  
pp. 662-668
Author(s):  
Mingming Han ◽  
Fang Kang ◽  
Chengwei Yang ◽  
Ziyou Liu ◽  
Ting Wang ◽  
...  
Keyword(s):  
Experimental Research ◽  
Local Anesthetics ◽  
Analgesic Effect ◽  
Sensory Block ◽  
Mechanisms Of Action ◽  
High Dose ◽  
Low Doses ◽  
Subcutaneous Injections ◽  
Injection Dose ◽  
The Difference

<b><i>Background:</i></b> Adrenaline (Adr) and dexmedetomidine (Dex) are commonly used adjuvants of local anesthetics; however, the difference in the improvement of analgesia of local anesthetics between the 2 adjuvants remains unclear. <b><i>Objective:</i></b> The objective of this experimental research was to evaluate the cutaneous analgesic effect of mexiletine (Mex) by coadministration with Dex or Adr. <b><i>Methods:</i></b> The effect of a nociceptive block was assessed based on the inhibition of the cutaneous trunci muscle reflex in response to skin pinpricks in rats. The analgesic activity of Mex alone and Mex coadministered with Dex or Adr was evaluated after subcutaneous injections. Subcutaneous injections of drugs or combinations include Mex 0.6, 1.8, and 6.0 μmol; Adr 13.66 nmol; Dex 1.05600 nmol; saline; and Mex 1.8 and 6.0 μmol, respectively, combined with Dex 0.01056, 0.10560, and 1.05600 nmol or Adr 0.55, 2.73, and 13.66 nmol, with each injection dose of 0.6 mL. <b><i>Results:</i></b> Subcutaneous injections of Mex elicited dose-related cutaneous analgesia. Compared with Mex (1.8 μmol), adding Dex or Adr to Mex (1.8 μmol) solutions for skin nociceptive block potentiated and prolonged the action. Mex (6.0 μmol) combined with Dex or Adr extended the duration of cutaneous analgesia when compared with Mex (6.0 μmol) alone. A high dose of Adr is more effective with Mex 1.8 μmol than that of Dex, whereas medium and low doses were less effective. Mex 6.0 μmol combined with any dose of Adr is superior to that of Dex. <b><i>Conclusions:</i></b> Both Dex and Adr improve the sensory block and enhance the nociceptive block duration of Mex. But in most cases, Adr is superior to Dex. It may be that different mechanisms of action of the 2 adjuvants lead to the differences.

Removal of inelastically scattered electrons substantially increases phase contrast on frozen-hydrated molecules

1987 ◽  
Vol 45 ◽  
pp. 652-653
Author(s):  
John P. Langmore ◽  
Brian D. Athey
Keyword(s):  
Electron Diffraction ◽  
Phase Contrast ◽  
Low Dose ◽  
Dark Field ◽  
Biological Structure ◽  
Bright Field ◽  
Low Contrast ◽  
Negative Stain ◽  
The Difference ◽  
Better Than

Although electron diffraction indicates better than 0.3nm preservation of biological structure in vitreous ice, the imaging of molecules in ice is limited by low contrast. Thus, low-dose images of frozen-hydrated molecules have significantly more noise than images of air-dried or negatively-stained molecules. We have addressed the question of the origins of this loss of contrast. One unavoidable effect is the reduction in scattering contrast between a molecule and the background. In effect, the difference in scattering power between a molecule and its background is 2-5 times less in a layer of ice than in vacuum or negative stain. A second, previously unrecognized, effect is the large, incoherent background of inelastic scattering from the ice. This background reduces both scattering and phase contrast by an additional factor of about 3, as shown in this paper. We have used energy filtration on the Zeiss EM902 in order to eliminate this second effect, and also increase scattering contrast in bright-field and dark-field.

PENERAPAN MODEL PEMBELAJARAN KOOPERATIF TIPE STAD DENGAN PENDEKATAN RME UNTUK MENINGKATKAN HASIL BELAJAR MATEMATIKA SISWA KELAS IX SMP MUHAMMADIYAH PADANG LUAS KECAMATAN TAMBANG KABUPATEN KAMPAR

2018 ◽  
Vol 2 (5) ◽  
pp. 744
Author(s):  
Zainur Zainur
Keyword(s):  
Action Research ◽  
Cooperative Learning ◽  
Student Learning ◽  
Learning Outcomes ◽  
Mathematics Learning ◽  
Student Learning Outcomes ◽  
Learning Model ◽  
Research Instrument ◽  
The Difference ◽  
Better Than

This research was motivated by the low learning outcomes of grade IX SMP Muhammadiyah Padang LuasKecamatan Tambang Kabupaten Kampar. This study aims to improve learning outcomes in mathematicslearning through STAD type cooperative learning with the RME approach in class IX SMP MuhammadiyahPadang Luas Kecamatan Tambang Kabupaten Kampar. The subjects of this study were all classes IX in SMPMuhammadiyah Padang Luas Kecamatan Tambang Kabupaten Kampar totaling 26 people. The form ofresearch is classroom action research. This research instrument consists of performance instruments and datacollection instruments in the form of teacher activity observation sheets and activities. The results of the studystated that there were significant differences between students' mathematics learning outcomes before applyingthe STAD type cooperative learning model with the RME approach with after applying the STAD typecooperative learning model with the RME approach. The difference shows student learning outcomes after theaction is better than before the action with completeness reaching 80.77% or 21 completed. Based on the resultsof the study and discussion it can be concluded that the application of STAD type learning model with RealisticMathematic Education (RME) approach can improve the learning outcomes of grade IX students of SMPMuhammadiyah Padang Luas Kecamatan Tambang Kabupaten Kampar on statistical material.

Green Synthesis and Enhanced CO2 Capture Performance of Perfluorinated Cerium-Based Metal-Organic Frameworks with UiO-66 and MIL-140 Topology

2018 ◽  
Author(s):  
Roberto D’Amato ◽  
Anna Donnadio ◽  
Mariolino Carta ◽  
Claudio Sangregorio ◽  
Riccardo Vivani ◽  
...  
Keyword(s):  
Photoelectron Spectroscopy ◽  
Metal Organic Frameworks ◽  
Isosteric Heat ◽  
Experimental Conditions ◽  
Cerium Ammonium Nitrate ◽  
Ideal Adsorbed Solution Theory ◽  
Metal Organic ◽  
Adsorbed Solution ◽  
Better Than ◽  
The Ideal

Reaction of cerium ammonium nitrate and tetrafluoroterephthalic acid in water afforded two new metal-organic frameworks with UiO-66 [F4_UiO-66(Ce)] and MIL-140 [F4_MIL-140A(Ce)] topologies. The two compounds can be obtained in the same experimental conditions, just by varying the amount of acetic acid used as crystallization modulator in the synthesis. Both F4_UiO-66(Ce) and F4_MIL-140A(Ce) feature pores with size < 8 Å, which classifies them as ultramicroporous. Combination of X-ray photoelectron spectroscopy and magnetic susceptibility measurements revealed that both compounds contain a small amount of Ce(III), which is preferentially accumulated near the surface of the crystallites. The CO<sub>2</sub> sorption properties of F4_UiO-66(Ce) and F4_MIL-140A(Ce) were investigated, finding that they perform better than their Zr-based analogues. F4_MIL-140A(Ce) displays an unusual S-shaped isotherm with steep uptake increase at pressure < 0.2 bar at 298 K. This makes F4_MIL-140A(Ce) exceptionally selective for CO<sub>2</sub> over N<sub>2</sub>: the calculated selectivity, according to the ideal adsorbed solution theory for a 0.15:0.85 mixture at 1 bar and 293 K, is higher than 1900, amongst the highest ever reported for metal-organic frameworks. The calculated isosteric heat of CO<sub>2 </sub>adsorption is in the range of 38-40 kJ mol<sup>-1</sup>, indicating a strong physisorptive character.

NDBEPR PROCESS OPTIMIZATION IN SBRs: REDUCTION OF EXTERNAL CARBON-SOURCE AND OXYGEN SUPPLY

1994 ◽  
Vol 30 (4) ◽  
pp. 169-179 ◽  
Author(s):  
Carl Demuynck ◽  
Peter Vanrolleghem ◽  
Carine Mingneau ◽  
Jan Liessens ◽  
Willy Verstraete
Keyword(s):  
Process Optimization ◽  
Phosphorus Removal ◽  
Numerical Optimization ◽  
Cost Savings ◽  
Operating Costs ◽  
Nitrification Rate ◽  
Aeration Time ◽  
Time Scheduling ◽  
Better Than ◽  
The Ideal

In SBR plants for nutrient removal it is often necessary to add supplementary rbCOD during the anoxic phase to obtain complete nitrogen removal. In addition to the aeration, this supply of high-quality BOD is a non-negligible part in the operating costs. Because of the complexity of the bighly interconnected biological processes a heuristic approach for process optimization is hardly possible. Therefore the Nitrification Denitrification Biological Excess Phosphorus Removal (NDBEPR) model of Wentzel et al. and a numerical optimization a1goritbm were used to optimize SBR time scheduling, i.e. minimize both effluent concentrations and operating costs. It was found that a sequence of short aerobic/anoxic phases appears to be better than the usual sequence (one aerobic phase followed by one anoxic phase). This result was validated on a 500 I scale SBR. The optimized process saves up to 50% on extra BOD supply and up to 30% on aeration time. Moreover, it was shown that these cost savings were not at the expense of the phosphorus removal efficiency or the nitrification rate. From an additional numerical optimization it was seen that the ideal SBR time scheduling may depend on the loading. Therefore. a control strategy hased on OUR and ORP measurements is proposed.

scholarly journals Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Pharmacology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Shan Deng ◽  
Yonghao Yu
Keyword(s):  
Femur Fracture ◽  
Meta Analysis ◽  
Sensory Block ◽  
Cochrane Library ◽  
Rescue Analgesia ◽  
Block Level ◽  
Block Time ◽  
Sedation Scores ◽  
The Difference ◽  
The Cochrane Library

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

scholarly journals Impact of media components from different suppliers on enterokinase productivity in Pichia pastoris

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ján Krahulec ◽  
Martin Šafránek
Keyword(s):  
Recombinant Proteins ◽  
Fermentation Process ◽  
High Impact ◽  
Production Level ◽  
Media Component ◽  
Component Supplier ◽  
The Media ◽  
The Difference ◽  
Optimisation Procedure ◽  
The Ideal

Abstract Background The aim of this study was to provide an information about the homogeneity on the level of enterokinase productivity in P. pastoris depending on different suppliers of the media components. Results In previous studies, we performed the optimisation process for the production of enterokinase by improving the fermentation process. Enterokinase is the ideal enzyme for removing fusion partners from target recombinant proteins. In this study, we focused our optimization efforts on the sources of cultivation media components. YPD media components were chosen as variables for these experiments. Several suppliers for particular components were combined and the optimisation procedure was performed in 24-well plates. Peptone had the highest impact on enterokinase production, where the difference between the best and worst results was threefold. The least effect on the production level was recorded for yeast extract with a 1.5 fold difference. The worst combination of media components had a activity of only 0.15 U/ml and the best combination had the activity of 0.88 U/ml, i.e., a 5.87 fold difference. A substantially higher impact on the production level of enterokinase was observed during fermentation in two selected media combinations, where the difference was almost 21-fold. Conclusions Results demonstrated in the present study show that the media components from different suppliers have high impact on enterokinase productivity and also provide the hypothesis that the optimization process should be multidimensional and for achieving best results it is important to perform massive process also in terms of the particular media component supplier .

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