protective effect of insulin against isoflurane and sevoflurane induced hepatocellular apoptosis

Several studies deducted that inhalational anesthetics induce apoptosis in human cells. Insulin is believed to have an antiapoptotic action so it is widely used as cardioprotective agent against ischemic reperfusion injuries. This study compared the apoptotic effect of inhalational anesthetics and figuring out the antiapoptotic effect of insulin against perioperative induced hepatocellular apoptosis using immune histochemical study of liver biopsy. Eighty [ASA I] patients scheduled for laparoscopic cholecystectomy were randomly allocated into 4 groups [20 patients each]. Two groups were anesthetized using isoflurane and the other two were anesthetized using sevoflurane. The control groups [IC, SC] received normal saline and the insulin groups [II, SI] received glucose, insulin and potassium [GIK] infusion. Infusions were given 2 hours before induction of anesthesia. Liver biopsy was taken before the umbilical port closure. In liver biopsy Caspase 3, 7, 9 and Akt activity were evaluated. Liver function tests were estimated before infusion and one day after surgery. Serum K and blood glucose levels were closely monitored all through the study. The results showed that in the isoflurane groups, the percentage of caspase 3 and 7 positive cases decreased while Akt positive cases increased significantly in II compared to IC respectively [p < 0.05]. In the sevoflurane groups, the percentage of caspase 3 positive cases decreased significantly in SI compared to SC group [p < 0.05]

effect of magnesium sulphate [MgSo4] pretreatment on atracurium induced neuromuscular blockade

Magnesium inhibits the release of acetylcholine from the motor nerve terminals and thus potentiates the action of the non- depolarizing neuromuscular blocking drugs. The effect of pretreatment with magnesium sulfate on the neuromuscular block after atracurium administration was studied. Forty adult patients were allocated randomly into two groups. Control group [n=20] received atracurium only, while the MgSO4 group [n=20] received atracurium after pretreatment with MgSO4 [40 mg kg-1]. In all patients midazolam was given as premedication and anesthesia was induced with fentanyl and thiopentone and tracheal intubation was performed with atracurium 0.5 mg kg-1. The neuromuscular transmission was monitored using mechanomyography and TOF stimulation. For each patient the onset time, the clinical duration, the recovery index were determined. The intubation time and the intubation conditions were also described. The results are given and discussed

Comparison of cardiovascular and neuromuscular properties of pancuronium, doxacurium and pipecuronium during induction of anesthesia for open heart surgery

This study compared hemodynamic and neuromuscular properties of pancuronium, doxacurium and pipecuronium during induction of anesthesia in 45 patients undergoing open valvular heart surgery. Anesthesia was induced with fentanyl 10 mg.kg-1 and thiopentone 23 mg.kg-1. Each patient received twice the ED95 of either pancuronium [0.15 mg.kg-1, n=15] or doxacurium [0.05 mg.kg-1, n=15] or pipecuronium [0.1 mg.kg-1 n=15]. Hemodynamic measurements were recorded before induction of anesthesia, before intubation, immediately after intubation and five minutes post-intubation. Pancuronium significantly increased heart rate and mean arterial blood pressure, but this decrease was not statistically significant and heart rate was nearly stable. On the other hand, there was minimal change in heart rate and mean arterial blood pressure with pipecuronium. Other hemodynamic parameters did not change. The time from muscle relaxant administration to 95% suppression of the first twitch of train of 4 stimuli was significantly longer for doxacurium than that for pancuronium and pipecuronium. Therefore, pipecuronium seems to be more satisfactory neuromuscular blocker than either pancuronium or doxacurium for induction of anesthesia for open heart surgery