Teneligliptin Co-Infusion Alleviates Morphine Tolerance by Inhibition of Spinal Microglial Cell Activation in Streptozotocin-Induced Diabetic Rats.

Morphine (MOR) is a commonly prescribed drug for the treatment of moderate to severe diabetic neuropathic pain (DNP). However, long-term MOR treatment is limited by morphine analgesic tolerance (MAT). The activation of microglial cells and the release of glia-derived proinflammatory cytokines are known to play an important role in the development of MAT. In this study, we aimed to investigate the effects of the dipeptidyl peptidase-4 inhibitor (DPP-4i) teneligliptin (TEN) on MOR-induced microglial cell activation and MAT in DNP rats. DNP was induced in four groups of male Wistar rats through a single intraperitoneal injection of streptozotocin (STZ) (50 mg/kg, freshly dissolved in 5 mmol/L citrate buffer, pH 4.5). Sham rats were administered with the vehicle. Seven days after STZ injection, all rats were implanted with an intrathecal (i.t) catheter connected to a mini-osmotic pump, divided into five groups, and infused with the following combinations: sham + saline (1 µL/h, i.t), DNP + saline (1 µL/h, i.t), DNP + MOR (15 µg/h, i.t), DNP + TEN (2 µg/h, i.t), and DNP + MOR (15 µg/h, i.t) + TEN (2 µg/h, i.t) for 7 days at a rate of 1 µL/h. The MAT was confirmed through the measurement of mechanical paw withdrawal threshold and tail-flick tests. The mRNA expression of neuroprotective proteins nuclear factor erythroid 2-related factor (Nrf2) and heme oxygenase-1 (HO-1) in the dorsal horn was evaluated by quantitative PCR (qPCR). Microglial cell activation and mononucleate cell infiltration in the spinal cord dorsal horn were assessed by immunofluorescence assay (IFA) and Western blotting (WB). The results showed that co-infusion of TEN with MOR significantly attenuated MAT in DNP rats through the restoration of neuroprotective proteins Nrf2 and HO-1 and suppression of microglial cell activation in the dorsal horn. Though TEN at a dose of 2 µg has mild antinociceptive effects, it is highly effective in limiting MAT.

[Applying Swanson's Caring Theory to a Patient With an Initial Diagnosis of Marfan's Syndrome With Aortic Dissection].

This article describes the author's experience using Swanson Care Theory in the provision of nursing care to a 20-year-old man, an exchange student from Hong Kong, following his initial diagnosis with Marfan's syndrome. This patient required emergency aortic root replacement surgery due to type A aortic dissection. Immediately after learning of his illness, the patient was faced with making a major surgical decision. The absence of relatives and friends close by to assist him made him unable to decide whether to agree to the operation. Because of the importance of evaluating the physical and mental needs of the case, which would affect his prognosis, the author conducted a four-facet physical, psychological, social, and spiritual assessment of the patient from April 13-18, 2020. The results confirmed the presence of significant health problems, including "body image disturbance" and "anxiety". The author applied the five processes of Swanson's caring theory in caring for this patient. The process of "Knowing" and "Being with" helped, through active companionship and care, establish a trusting relationship, elucidate the client's inner thoughts on the disease, evaluate the client's needs, and accept the negative emotions. The process of "Doing for" and "Enabling" were employed to serve as a bridge for family communication to help both parties achieve consensus and to encourage effective problem-facing, provide timely assistance, promote self-adjustment, and reduce psychological shock, unease, and anxiety. Health education was implemented to increase the patient's disease and postoperative-care knowledge and promote self-care abilities to facilitate his acceptance of the current situation and active participation in treatment. Finally, the process of "Maintaining belief" was used to elicit positive feedback through actual situations. Patients with conditions similar to this patient were introduced to share their experiences and provide empathy to provide our patient with the motivation necessary to maintain positive progress. Based on this experience, it is recommended that critical caregivers strengthen their caring ability to improve their quality of care. This experience is may be referenced by clinical workers.

Postoperative Serotonin Syndrome Following Administration of Preoperative Intrapulmonary Methylene Blue and Intraoperative Granisetron: A Case Report.

BACKGROUND Methylene blue (MB), which is often used perioperatively, is a potent monoamine oxidase inhibitor that can strongly block the clearance of extracellular serotonin. Granisetron, a serotonin receptor subtype 3 (5-HT3) antagonist, is an antiemetic used to prevent or treat postoperative nausea and vomiting (PONV). Through its antagonism, granisetron can increase the extracellular serotonin concentration. Serotonin syndrome is a potentially life-threatening condition resulting from a drug reaction that affects serotonin levels. This report is of a 50-year-old woman with postoperative serotonin syndrome following co-administration of preoperative intrapulmonary methylene blue and intraoperative granisetron. CASE REPORT A 50-year-old woman with well-controlled gastroesophageal regurgitation disease presented under impression of lung cancer. She received a computed tomography (CT)-guided localization followed by video-assisted thoracic surgery under endotracheal general anesthesia. The surgery was completed uneventfully. Her postoperative course was significant for serotonin syndrome, likely triggered by co-administration of preoperative intrapulmonary MB for tumor localization and intraoperative granisetron. Other differential diagnoses were ruled out. Her management was primarily supportive, using benzodiazepine administration, and resulted in full neurologic recovery. CONCLUSIONS Intrapulmonary MB can lead to serotonin syndrome in combination with 5HT-3 antagonists when used for preoperative tumor localization. Because both MB and 5-HT3 antagonists are being widely used clinically at present, this report has highlighted that physicians, surgeons, and anesthesiologists should be aware of serotonin syndrome, its presenting features, and management, and its association with the use of methylene blue and 5-HT3 receptor antagonists, including granisetron.

Enhanced Perioperative Safety and Comfort During Airway-Related Surgeries and Procedures With Dexmedetomidine-A Brief Review and Clinical Practice Experience.

Dexmedetomidine, an α-2 adrenergic receptor agonist, provides analgesia, sedation, anxiolysis, sympatholysis and anesthetic-sparing effect, without inducing significant respiratory depression. Due to these properties, its clinical use is no longer limited to serving as a sedative agent in the intensive care unit. Proper airway management and the avoidance of cardiac and respiratory complications are common goals of everyday anesthesia practice. Ensuring airway safety is pivotal during the anesthesia stages of induction, maintenance and recovery. In this review, we focus on the advantages of dexmedetomidine in awake fiberoptic intubation (AFOI), diagnostic examinations and surgeries of patients with obstructed airways, and reducing emergence delirium effectively without causing further adverse events. With increasing implementation in different anesthetic scenarios, dexmedetomidine provides a favorable option to enhance patient safety and comfort.