Blood biomarkers alterations with administration of propofol for anaesthesia maintenance during long term oral and maxillofacial surgeries

Objective: This prospective study performed to evaluate blood biomarkers alterations with administration of propofol for maintenance of anaesthesia during long oral and maxillofacial surgeries in order to estimate the risk of Propofol Infusion Syndrome [PRIS]. This rare syndrome often would be happened in long duration or high dose infusion which is characterized by the combination of metabolic acidosis, acute bradycardia and/or asystole, and rhabdomyolysis and can be fatal

Methods: Patients undergoing maxillofacial surgeries [>3h] were the subjects of this quasi experimental prospective clinical trial study. Induction of anaesthesia was performed with midazolam 0.025 mg/kg, fentanyl 2 micro g/kg, thiopental sodium 5 mg/kg, and atracurium 0.5 mg/kg. Infusion of propofol was initiated [100 micro g/kg/min] for maintenance of anesthesia. Serum potassium level, creatine kinase, lactate and blood PH, were evaluated at baseline, and at 2, 4, 6 hours following the initiation of propofol infusion. Generalized estimating equation was used to evaluate the longitudinal changes for each of the evaluated biomarkers. The relation between the biomarkers and the following factors were appraised by using covariance linear [enter mode] regression analysis: age, gender, weight, administered dose of dexamethasone and epinephrine, duration of surgery, and a history of trauma prior to surgery

Results: A total of 55 participants, 31 women and 24 men, were studied. The mean duration of surgery was 4.8[1] hours. Despite the rise in the level of potassium and creatine kinase and the reduction of blood PH, no case of hyperkalemia or severe metabolic acidosis was observed. Serum lactate level gradually increased to higher than normal in few patients; though did not necessitate any intervention. All alterations were statistically significant. Potassium and creatine kinase level at baseline had relation to pre-surgical trauma

Conclusion: Maintenance of anaesthesia with 100 micro g/kg/min propofol along with administration of low-dose epinephrine and dexamethasone did not cause clinically important alterations in blood biomarkers during long-duration maxillofacial surgeries and might not cause PRIS

[Rhino-orbito cerebral mucormycosis in an otherwise healthy patient with no history of systemic disease: a case report and review of literature]

Rhino-orbito-cerebral mucormycosis is a rare invasive fungal disease, which often has a fulminant and characteristic clinical course. The patients are usually immune-compromised, with diabetic ketoacidosis. The underlying disease is an important factor determining the prognosis of infection and response to treatment. The authors report a case of fulminant rhino-orbito-cerebral mucormycosis with no apparent underlying disease. Therapy included surgical intervention and systemic administration of amphotericin B. However, due to the aggressive behavior of disease and occult underlying systemic condition the treatment was unsuccessful and the patient died after debridement and medical therapy. Only a few cases of Rhino-orbito-cerebral Mucormycosis have been reported in the literature with no identified predisposing factor. In our case, no specific predisposing factors were found accompanying the fulminant progression of rhino-orbito-cerebral mucomycosis

[Histological evaluation of regeneration in rabbit calvarial bone defects using demineralized bone matrix, mesenchymal stem cells and platelet rich in growth factors]

Regeneration of large bone defects is a major challenge in maxillofacial reconstruction. The present study evaluated the efficacy of simultaneous use of demineralized bone matrix [DBM], mesenchymal stem cells [MSCs] and platelet rich in growth factors [PRGF]. Stem cells were isolated from the femoral bone marrow of rabbits and their stem cell nature was confirmed. PRGF was prepared by drawing 5 cc of blood from the heart of rabbits and its centrifugation. A total of four 8mm defects were surgically created in rabbits calvaria using a trephine bur. Third passage cells were loaded on DBM and stored in an incubator for 24 hours. DBM, DBM+PRGF, DBM+MSCs and DBM+PRGF+MSCs were used in groups 1, 2, 3, and 4, respectively. At 6 and 12 weeks rabbits were sacrificed using vital perfusion. Histomorphometric analysis was performed on 5 micro m sections stained with Hematoxylin and Eosin [H and E]. Data were analyzed using SPSS version 14 software and ANOVA test. Histomorphometric analysis of the sections at 6 and 12 weeks post-operation demonstrated 74.6% and 20.31% osteogenesis in group 1, 14.35% and 28.44% in group 2, 17.75% and 31.33% in group 3 and 18.94% and 37.21% in group 4, respectively. Percentage of new bone formation was higher in group 4. However, this difference was not statistically significant [P>0.05]. It seems that simultaneous use of DBM, PRGF and MSCs results in increased bone regeneration in 8 mm rabbit calvarial bone defects when compared to the application of MSCs or PRGF alone

Craniomaxillofacial bone engineering by scaffolds loaded with stem cells: a systematic review

The concept of tissue engineering holds huge promise for the future treatment of osseous defects. For bone tissue engineering, stem cells are applied on supporting scaffolds under controlled stimulation with growth factors. Scaffolds are provisional matrices for bone growth providing a specific environment for tissue development and favoring cellular attachment, growth and differentiation. To date, ceramics, polymers, and composite scaffolds have been widely used for bone tissue engineering in various in-vitro and animal studies. The objective of this article was to review the advances in jaw bone engineering from a scaffold material point of view. A review of literature was carried out by using Medline database and searching topics like "craniomaxillofacial tissue engineering", "bone regeneration", "scaffold", "oral surgery", "stem cell+ scaffold", "xenograft" and "allograft". Animal and human studies evaluating repair of craniomaxillofacial defects with scaffold and stem cells, were considered in this study. A total of 64 studies were evaluated. Based on the results of this literature review, although autogenous bone grafting has remained the preferred strategy for treatment of bone defects, rapid prototyping [RP] techniques do offer great opportunities to generate suitable scaffolds for bone tissue engineering in near future