In the present article, recent research efforts in our laboratory to improve cryosurgery by use of mechanistically derived adjuvants are reviewed. Our research has been focused on enhancing two freezing induced injury mechanisms -i) direct cell injury by use of thermophysical adjuvants, and ii) vascular injury by use of an inflammatory adjuvant. The thermophysical adjuvants are chemicals, usually salts, which can induce secondary crystallization, called eutectic solidification, in a cryolesion; thereby enhancing direct cell injury. The inflammatory adjuvant is a cytokine, tumor necrosis factor-alpha (TNF-α), which upregulates inflammation of microvasculature in tumors prior to freezing to promote vascular injury in the cryolesion. Even though the individual mechanism of injury enhancement within the cryolesion of each adjuvant requires further study, both adjuvants are envisioned to enlarge the complete killing zone so that the boundary of the cryolesion matches more closely with the edge of iceball. By bringing the edge of the cryolesion closer to the edge of iceball, the adjuvants hold promise for improvement of image guidance and outcome of cryosurgery.
Objective: This study aims to compare the effectiveness of dexmedetomidine and propofol in responding to hemodynamic changes to pneumoperitoneum during laparoscopic cholecystectomy, as well as to evaluate differences in the time it takes to extubate, the patient's hemodynamic status upon extubation, the patient's level of sedation following extubation, and the occurrence of any side effects. Study Design: Prospective, Randomized Controlled Trial Study Place and Duration: Liaquat National Hospital and Medical College, Karachi. Conducted over a period of 6months from January 2022 to June 2022 Methods: A total of 100 patients (aged 20-60) in Physical Status Classes 1 and 2 as defined by the American Society of Anesthesiologists were randomly split into two groups (P and D). Patients in Group P were given propofol at a rate of 100 micrograms per kilogramme per minute (g/kg/min) after intubation until the end of pneumoperitoneum, while those in Group D were given dexmedetomidine at a rate of 1 micro Multiple readings of HR and MAP were taken at different points in the operation. Measurements of the Resuscitation Success Rate (RSR) and the Modified Alderate Scale (MAS) were also taken 15 and 30 minutes after operation. Results: Showed that during pneumoperitoneum, Group D significantly decreased HR and MAP compared to Group P, which allowed for superior preservation of hemodynamic stability. In contrast to Group P, patients in Group D remained sleepy for up to 30 minutes after surgery. Conclusion: Dexmedetomidine is more effective at suppressing the hemodynamic stress response to pneumoperitoneum during infusion than propofol is, whereas propofol is more effective at speeding up recovery time. Keywords: Dexmedetomidine, hemodynamics, laparoscopy, propofol, pneumoperitonuim
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