Objective Acute lung injury is responsible for mortality in seriously ill patients. Previous studies have shown that systemic inflammation is attenuated by remote ischemic preconditioning (RIPC) via reducing nuclear factor-kappa B (NF-κB). Therefore, we investigated whether lipopolysaccharide (LPS)-induced indirect acute lung injury (ALI) can be protected by RIPC. Methods RIPC was accomplished by 10 minutes of occlusion using a tourniquet on the right hind limb of mice, followed by 10 minutes of reperfusion. This process was repeated three times. Intraperitoneal LPS (20 mg/kg) was administered to induce indirect ALI. Inflammatory cytokines in bronchoalveolar lavage fluid were analyzed using an enzyme-linked immunosorbent assay. Pulmonary tissue was excised for histological examination, and for examining NF-κB activity and phosphorylation of inhibitor of κBα (IκBα). Results NF-κB activation and LPS-induced histopathological changes in the lungs were significantly alleviated in the RIPC group. RIPC reduced phosphorylation of IκBα in lung tissue of ALI mice. Conclusions RIPC attenuates endotoxin-induced indirect ALI. This attenuation might occur through modification of NF-κB mediation of cytokines by modulating phosphorylation of IκBα.
Hyperthyroidism is one of the most common endocrinologic disorders. When patients with hyperthyroidism undergo general anesthesia, potential perioperative complications such as atrial fibrillation, congestive heart failure, ischemic heart disease, thrombocytopenia may occur. Hyperthyroidism treatment is mainly divided into three parts: Medical treatment, radioactive iodine therapy, and surgical removal of the thyroid. However, the previous two treatments may not have a significant effect on patients with liver failure. In this report, we present a case where a patient with an underlying disease of uncontrolled hyperthyroidism and liver failure undergoing liver transplantation, where preoperative thyroid levels couldn't be managed aggressively due to liver failure. We managed hyperthyroidism using conservative management before and during surgery; perioperative use of steroids, beta-blockers, calcium channel-blockers, IV (Intravenous) fluids, body temperature regulation, opioid use such as remifentanil and fentanyl, sufficient sedation are all key in ensuring the hemodynamic stability of such a patient.
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