Abstract:Objective: To evaluate the effects of tramadol on the proinflammatory responses in a rat model of incisional pain by investigating its effects on nociceptive thresholds and serum interleukin-6 (IL-6) and IL-2 levels. Methods: Forty-two male Sprague-Dawley (SD) rats scheduled for plantar incision were randomly divided into 7 groups (n=6 in each group). Rats in Group 1 receiving general anesthesia with no incision were served as control; At 30 min before skin incision, Groups 2~5 were given 5 ml normal saline or 1, 10, and 20 mg/kg tramadol, respectively, intraperitoneally (i.p.); Group 6 received 10 mg/kg tramadol after operation; Group 7 received 10 mg/kg tramadol before incision, followed by 200 μg/kg naloxone after operation. Mechanical allodynia was measured by electronic von Frey filament to evaluate the nociceptive thresholds 1 h before incision, and 1 h and 2 h after operation. Serum IL-6 and IL-2 levels were measured by enzyme-linked immunosorbent assay (ELISA) 2 h after operation. Results: Mechanical thresholds decreased significantly and serum IL-6 level increased significantly after operation in Group 2 compared with control (P<0.01), and these changes were reversed respectively by tramadol in a dose-dependent manner (P<0.05 and P<0.01, respectively). IL-2 level remained unchanged after operation in Group 2, but decreased in Group 3 (P<0.05), then gradually returned to the normal level in Groups 4 and 5. The intraperitoneally injected tramadol (10 and 20 mg/kg) produced a potent and dose-dependent antinocicptive effect on the lesioned paw. The antinocicptive effects of tramadol were partially antagonized by naloxone (200 μg/kg), suggesting an additional non-opioid mechanism. Conclusion: The results suggest that tramadol could be a good choice for the treatment of pain under the conditions that immunosuppression may be particularly contraindicated.
Purpose Dexmedetomidine (DEX) stabilizes intraoperative blood glucose levels and reduces insulin resistance (IR), a common perioperative complication. However, the molecular mechanisms underlying these effects remain unclear. Since endoplasmic reticulum stress (ERS) is a mechanism of IR, this study sought to examine whether DEX can effectively alleviate IR by reducing ERS. Methods HepG2 and LO2 cells were treated with different concentrations of insulin. The glucose content assay and Cell Counting Kit-8 (CCK-8) were then employed to determine the optimal insulin concentration capable of inducing IR without affecting cell viability. Insulin-resistant hepatocytes were cultured with different concentrations of DEX for 24 h, and the glucose concentration in the supernatant was measured. ERS was assessed by qPCR and western blotting. The latter was also used to quantify the expression of phosphorylated protein kinase B (p-AKT), phosphoenolpyruvate carboxykinase (PEPCK), and glucose 6 phosphatase (G6Pase), which are key proteins involved in the action of insulin. Results After 48-h of culturing with 10 μg/mL insulin, glucose consumption in hepatocytes was found to be reduced. IR hepatocytes cultured with 10, 100, or 1000 ng/ml DEX for 24 h showed a concentration-dependent increase in glucose consumption. Elevated mRNA and protein levels of ERS markers binding immunoglobulin protein (BIP) and ER protein 29 (ERp29), were reversed by DEX treatment. Moreover, reduced p-AKT and increased PEPCK and G6Pase protein levels in IR hepatocytes were also restored following DEX treatment. Conclusion DEX may alleviate IR in hepatocytes by reducing ERS serving to restore insulin action via the IRS-1/PI3K/AKT pathway.
Purpose: To observe the effects of different levels of positive end-expiratory pressure (PEEP) ventilation strategies on pulmonary compliance and complications in patients undergoing robotic-assisted laparoscopic prostate surgery.Methods: A total of 120 patients with American Society of Anesthesiologists Physical Status Class I or II who underwent elective robotic-assisted laparoscopic prostatectomy were enrolled. The patients were randomly divided into three groups of 40 patients each: control (PEEP=0 cmH2O), low-level (PEEP=5 cmH2O), and high-level (PEEP=10 cmH2O). Volume control ventilation with an intraoperative deep muscle relaxation strategy was used intraoperatively. Respiratory mechanics indexes were recorded at six time points: 10 min after anesthesia induction, immediately after pneumoperitoneum establishment, 30 min, 1 h, 1.5 h, and at the end of pneumoperitoneum (T1-T6). Arterial blood gas analysis and oxygenation index calculation were performed at T1, T4, and after tracheal extubation (T7). Postoperative pulmonary complications were also recorded.Results: After pneumoperitoneum, peak inspiratory pressure (Ppeak), plateau pressure (Pplat), mean pressure (Pmean), driving pressure (ΔP), and airway resistance (Raw) increased significantly and pulmonary compliance (Crs) decreased, persisting during pneumoperitoneum in all groups. Between T2–T5, Pulmonary compliance in Group high-level was higher compared with Groups low-level (53.7/39.2/37.2/35.8 vs. 46/33.6/33.7/32.5; P<0.05) and control (53.7/39.2/37.2/35.8 vs. 38.4/28.2/26.7/27.4; P<0.05) .The driving pressure (ΔP) at T2–T5 in Group high-level was lower compared with Groups low-level (9.7/13.2/13.8/14.3 vs. 12.3/16.0/16.2/17.3; P<0.05) and control (9.7/13.2/13.8/14.3 vs. 17.0/21/22.3/22.0; P<0.05).At T4 and T7, the PaCO2 and PaO2/FiO2 did not significantly differ among the three groups((P>0.05). There was no significant difference in postoperative pulmonary complications among the three groups(P>0.05).Conclusion: High levels of intraoperative PEEP increased lung compliance without significantly reducing postoperative pulmonary complications.Registered:The study was registered in the China Clinical Trials Registry 30/05/ 2020 (Registration No. ChiCTR2000033380).
Background Left ventricular mural thrombus (LVMT) is a life-threatening complication in patients with left ventricular dysfunction. Case presentation A 67-year-old man had a history of penetrating myocardial infarction and left ventricular aneurysm (LVA). The patient was scheduled for a non-cardiac surgery and stopped aspirin for 10 days to reduce the risk of bleeding. Fresh LVMT was revealed via the transesophageal echocardiography (TEE) after the preoperative discontinuation of aspirin. Conclusions Perioperative repeated evaluation for the thrombosis by echocardiography is essential in cases of patients with cardiovascular disease undergoing non-cardiac surgery. In high risk patient, during temporary interruption of antiplatelets, bridging with perioperative low-molecular-weight heparin is advisable.
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