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Topic Review
Xenograft Model in Animal Models of Cancer
Animal models of cancer may be classified in a variety of ways. Most simply, they are either spontaneous or induced and mammalian or non-mammalian. Alternatively, they may be categorized by the method of inducing cancer occurrence. A xenograft model involves the transplantation of cancer cells from one species (e.g., human) into a host animal of a different species (e.g., mouse).
  • 1.7K
  • 18 Oct 2022
Topic Review
Local Anesthesia in Cancer Surgeries
The application of local anaesthetics is frequently involved in anaesthesia in the surgical treatment of various cancers. It is used in addition to or instead of general anaesthesia as a way to provide control of sensation and pain to specific regions or parts of the patients' bodies. They are thought to reduce the requirement for volatile anaesthetics and opioids used in the surgery.
  • 1.5K
  • 28 Feb 2021
Topic Review
Vasovagal Reactions during Interventional Pain Management Procedures
Vasovagal reactions—defined as a rapid drop in heart rate and/or blood pressure, usually in response to a stressful trigger—are a common complication of interventional pain management procedures. Three types of vasovagal responses have been described in the literature: a cardioinhibitory form (HR < 40 bpm), vasodepressor form (SBP < 80 mmHg or decrease by >30% without significant HR reduction), or mixed form (HR < 40 bpm and SBP < 80 mmHg or decrease by >30%). Typical symptoms of a vasovagal reaction are lightheadedness or dizziness, palpitations, weakness, blurred vision, nausea, feelings of warmth or coldness, and sweating. When a vasovagal reaction results in a loss of consciousness, it is termed vasovagal syncope. Although vasovagal reactions are usually benign in nature, they can lead to more serious complications for both patients and providers, such as aborted procedures, cardiac arrythmias, or fear of future procedures. It is thus useful for pain medicine clinicians to identify the risk factors, prevention, and management of vasovagal reactions in an outpatient setting.
  • 1.4K
  • 03 Aug 2022
Topic Review
Neuro-Monitoring in Intravenous Anaesthesia
The monitoring of hypnosis depth by means of electroencephalogram-based (EEG-based) systems is emerging in paediatric anaesthesia common practice. This monitor system measures specific EEG signs which derive from anaesthetic-induced changes in neuronal firing.
  • 1.4K
  • 30 Jun 2021
Topic Review
Patient-Controlled Analgesia
Patient-controlled analgesia (PCA) is an effective method for controlling acute pain, including postoperative pain in adults and in children from five years of age, pain resulting from labor, trauma, or other medical situations, or chronic and malignant pain. The treatment consists of a mini-computer-controlled infusion pump permitting the administration of on-demand, continuous, or combined doses of analgesic (mainly opioid) variations in response to therapy, which allows pain to be significantly controlled. Intravenous (IV)-PCA minimizes individual pharmacodynamics and pharmacokinetic differences and is widely accepted as a reference method for mild or severe postoperative pain. IV-PCA is the most studied route of PCA; other delivery methods have been extensively reported in the literature. In addition, IV-PCA usually voids the gap between pain sensation and analgesic administration, permitting better recovery and fewer side effects. The most commonly observed complications are nausea and vomiting, pruritus, respiratory depression, sedation, confusion and urinary retention. However, human factors such as pharmacy preparation and device programming can also be involved in the occurrence of these complications, while device failure is much less of an issue. 
  • 1.2K
  • 10 Mar 2022
Topic Review
Anesthesia in Children with Neuroblastoma
Neuroblastoma (NB) is the most common extracranial, solid, pediatric malignancy and, despite the constant progress of treatment and development of innovative therapies, remains a complex, challenging disease causing major morbidity and mortality in children.
  • 1.2K
  • 03 Jun 2021
Topic Review
Neuropathic Pain
Neuropathic pain in humans arises as a consequence of injury or disease of somatosensory nervous system at peripheral or central level. Peripheral neuropathic pain is more common than central neuropathic pain, and is supposed to result from peripheral mechanisms, following nerve injury. The animal models of neuropathic pain show extensive functional and structural changes occurring in neuronal and non-neuronal cells in response to peripheral nerve injury. These pathological changes following damage lead to peripheral sensitization development, and subsequently to central sensitization initiation with spinal and supraspinal mechanism involved. The aim of this narrative review paper is to discuss the mechanisms engaged in peripheral neuropathic pain generation and maintenance, with special focus on the role of glial, immune, and epithelial cells in peripheral nociception. Based on the preclinical and clinical studies, interactions between neuronal and non-neuronal cells have been described, pointing out at the molecular/cellular underlying mechanisms of neuropathic pain, which might be potentially targeted by topical treatments in clinical practice. The modulation of the complex neuro-immuno-cutaneous interactions in the periphery represents a strategy for the development of new topical analgesics and their utilization in clinical settings.
  • 1.2K
  • 18 Feb 2021
Topic Review
Nociceptive TRP Channel
Transient receptor potential (TRP) channels have emerged as key molecular identities in the sensory transduction of pain-producing stimuli. The ability of nociceptors to behave as noxious stimuli detectors relies on the presence of specialized transducing molecules at their peripheral nerve terminals capable of transforming the harmful physical (thermal and mechanical) and chemical stimuli into generator potentials. Upon nerve terminal stimulation, the output signal conveying to the central nervous system depends on the properties of transducer channels which produce generator potentials. Voltage-gated channels subsequently translate it into action potential firing. Nociceptive TRP channels are among the most studied transducer channels expressed in nociceptors and play a pivotal role in the study of pain.
  • 1.0K
  • 09 Feb 2021
Topic Review
The Coupling in Biological Membranes
Cell membrane structure is proposed as a lipid matrix with embedded proteins, and thus, their emerging mechanical and electrostatic properties are commanded by lipid behavior and their interconnection with the included and absorbed proteins, cytoskeleton, extracellular matrix and ionic media. Structures formed by lipids are soft, dynamic and viscoelastic, and their properties depend on the lipid composition and on the general conditions, such as temperature, pH, ionic strength and electrostatic potentials. The dielectric constant of the apolar region of the lipid bilayer contrasts with that of the polar region, which also differs from the aqueous milieu, and these changes happen in the nanometer scale. Besides, an important percentage of the lipids are anionic, and the rest are dipoles or higher multipoles, and the polar regions are highly hydrated, with these water molecules forming an active part of the membrane. Therefore, electric fields (both, internal and external) affects membrane thickness, density, tension and curvature, and conversely, mechanical deformations modify membrane electrostatics. As a consequence, interfacial electrostatics appears as a highly important parameter, affecting the membrane properties in general and mechanical features in particular.
  • 981
  • 12 Jul 2021
Topic Review
Cardiothoracic Surgical Critical Care Medicine
Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry.
  • 927
  • 09 Jan 2023
Topic Review
Phonomyography on Perioperative Neuromuscular Monitoring
Muscle contraction by lateral movement of muscle fibers can create acoustic signals with a low frequency, and the signals that occur can be transmitted to the surface of the skin. After collection and filtration, these sound signals will be transferred into electric signals, which can be evaluated quantitatively for perioperative neuromuscular monitoring.
  • 918
  • 12 Apr 2022
Topic Review
General Anesthesia
Vertebral lumbar surgery can be performed under both general anesthesia (GA) and spinal anesthesia. A clear benefit from spinal anesthesia (SA) remains unproven.
  • 876
  • 20 Jan 2021
Topic Review
Treatment of Chronic Pain
The International Association for Study of Pain defines it as “an unpleasant sensory and emotional experience associated with or resembling that associated with, actual or potential tissue damage” . 
  • 874
  • 30 Jun 2022
Topic Review
Endocrine Challenges with Continuous-Flow LVADs
Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement.
  • 865
  • 02 Jul 2021
Topic Review
Vasopressin in Sepsis and Other Shock States
Septic shock is defined by the need for vasopressors to correct hypotension and lactic acidosis secondary to infection, with a high mortality rate. The Surviving Sepsis Campaign guidelines recommend vasopressin as a second-line vasopressor, added to norepinephrine. 
  • 781
  • 07 Nov 2023
Topic Review
Preoperative Anemia in Vascular Patients
Anemia is a common condition in preoperative period of peripheral arterial disease patients. Anemia has multifactorial causes, including: iron deficiency; vitamin deficiency and inflammation; and chronic kidney disease. Some retrospective researches demonstrated, that preprocedural anemia is a predictor adverse outcomes in patients undergoing percutaneous transluminal angioplasty for vascular disease treatment. These outcomes are increase likelihood of: A) transfusion; B) amputation; C) and major adverse cardiovascular events.It is not clear if preoperative anemia optimization with iron and/or erythropoietin, reduce major adverse outcomes in patients submitted to vascular peripheral surgeries. 
  • 780
  • 04 Aug 2021
Topic Review
Applications of Artificial Intelligence in Anesthesia
The field of anesthesia has always been at the forefront of innovation and technology, and the integration of Artificial Intelligence (AI) represents the next frontier in anesthesia care. The use of AI and its subtypes, such as machine learning, has the potential to improve efficiency, reduce costs, and ameliorate patient outcomes. AI can assist with decision making, but its primary advantage lies in empowering anesthesiologists to adopt a proactive approach to address clinical issues. The potential uses of AI in anesthesia can be schematically grouped into clinical decision support and pharmacologic and mechanical robotic applications.
  • 769
  • 19 Jun 2023
Topic Review
Volatile Anesthetic-Induced Organ Protection
Ischemia reperfusion injury (IRI) is inevitable in kidney transplantation and negatively impacts graft and patient outcome. Reperfusion takes place in the recipient and most of the injury following ischemia and reperfusion occurs during this reperfusion phase; therefore, the intra-operative period seems an attractive window of opportunity to modulate IRI and improve short- and potentially long-term graft outcome. Commonly used volatile anesthetics such as sevoflurane and isoflurane have been shown to interfere with many of the pathophysiological processes involved in the injurious cascade of IRI. 
  • 743
  • 29 Apr 2021
Topic Review
Intranasal Administration for Pain
Pain, and particularly chronic pain, remains one of the most debilitating and difficult to treat conditions in medicine. Chronic pain is difficult to treat, in part, because it is associated with plastic changes in the peripheral and central nervous systems. Polypeptides are linear organic polymers that are highly selective molecules for neurotransmitter and other nervous system receptors sites, including those associated with pain and analgesia, so have tremendous potential as pain therapeutics. However, delivery of polypeptides to the nervous system is largely limited due to rapid degradation within the peripheral circulation as well as the blood-brain barrier. One strategy that has been shown to be successful in nervous system deposition of polypeptides is intranasal (IN) delivery. In this narrative review, we discuss the delivery of polypeptides into the peripheral and central nervous systems following IN administration. We briefly discuss the mechanism of delivery via the nasal-cerebral pathway. We review recent studies that demonstrate that polypeptides such as oxytocin, delivered IN, not only reach key pain modulating regions in the nervous system but in doing so, evoke significant analgesic effects. IN administration of polypeptides has tremendous potential to provide non-invasive, rapid, and effective methods of delivery to the nervous system for chronic pain treatment and management.
  • 741
  • 23 Jul 2021
Topic Review
Pancreatic Cancer and Microenvironments: Implications of Anesthesia
Pancreatic malignancy is a lethal neoplasm, as well as one of the leading causes of cancer-associated mortality, having a 5-year overall survival rate of less than 10%. The average life expectancy of patients with advanced pancreatic cancer does not exceed six months. Although surgical excision is a favorable modality for long-term survival of pancreatic neoplasm, metastasis is initially identified in nearly 80% of the patients by the time of diagnosis, making the development of therapeutic policy for pancreatic cancer extremely daunting. Emerging evidence shows that pancreatic neoplastic cells interact intimately with a complicated microenvironment that can foster drug resistance, metastasis, or relapse in pancreatic cancer. As a result, the necessity of gaining further insight should be focused on the pancreatic microenvironment contributing to cancer progression. Numerous evidence reveals that perioperative factors, including surgical manipulation and anesthetics (e.g., propofol, volatile anesthetics, local anesthetics, epidural anesthesia/analgesia, midazolam), analgesics (e.g., opioids, non-steroidal anti-inflammatory drugs, tramadol), and anesthetic adjuvants (such as ketamine and dexmedetomidine), might alter the tumor microenvironment and cancer progression by affecting perioperative inflammatory or immune responses during cancer surgery. 
  • 728
  • 09 Jun 2022
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