An in vitro assessment of teething gels' effects on human gingival mesenchymal stem cells.

BACKGROUND: The aim of this study is to examine the cytotoxic effects of dental gels with different contents, which are frequently used during teething, on gingival mesenchymal stem cells (G-MSCs). METHOD: The teething gels used in this study were Dentinox, Gengigel, Osanite, and Jack and Jill. The human gingival mesenchimal stem cells (hG-MSCs) were incubated with these teething gel solutions (0.1%, 50% and 80% concentrations). Reproductive behavior of G-MSCs was monitored in real time for 72 h using the xCELLigence real-time cell analyzer (RTCA) system. Two-way repeated Anova test and post hoc Bonferroni test were used to evaluate the effect of concentration and dental gel on 0-hour and 72-hour viability. Significance was evaluated at p < 0.05 level. RESULTS: Teething gels prepared at 50% concentration are added to the G-MSC culture, the "cell index" value of G-MSCs to which Dentinox brand gel is added is significantly lower than all other groups (p = 0.05). There is a statistically significant difference between the concentrations in terms of cell index values at the 72nd hour compared to the 0th hour (p = 0.001). CONCLUSIONS: The local anesthetic dental gels used in children have a more negative effect on cell viability as concentration increases.

Treating Femoral Artery Pseudoaneurysm by Tumescence Anesthesia and Echo-Guided Compression Technique (TACT): Clinical Outcome in 82 Consecutive Patients.

PURPOSE: Pseudoaneurysm (PA) of the access artery is a common and potentially severe complication after percutaneous endovascular interventions. Most PA require interventional therapy, including thrombin injection, covered stent implantation, or surgical repair, which are costly and associated with other complications. Treating PA by external compression is uncomfortable and time consuming, with a low success rate. By injecting local tumescence anesthesia around the PA and close to its neck, the tumescence anesthesia and echo-guided compression technique (TACT) aims to improve efficacy and patient's comfort. MATERIALS AND METHODS: We retrospectively reviewed all consecutive patients treated for femoral PA in our center from May 2009 to July 2019 and estimated efficacy and safety. Vascular specialists performed TACT according to a standardized protocol including ultrasound-guided injection of tumescence solution (45 ml of 0.9% saline, 15 ml of lidocaine 1%/epinephrine 5 µg/ml) in the soft tissue around the PA and its neck, local compression with the sonography probe until PA closure, and external compression by elastic belt for 3 hours. RESULTS: Among a total of 125 patients with femoral artery PA, 82 (65.6%) were treated by TACT (including 3 patients with haemorrhagic shock), 14 (11.2%) by thrombin injection; 12 (9.6%) by endovascular interventions; 8 (6.4%) by open surgery; and 9 (7.2%) conservatively. In patients treated by TACT, PA neck was short (<1 cm) in 51.8% and mean cavity diameter 30 ± 23 mm. After injection of 58 ± 8 ml of tumescence solution, mean time of echo-guided compression was 12 ± 8 minutes. Pseudoaneurysm was successfully closed in 92.7% after the first attempt and in 96.3% after the second attempt. The intervention was well tolerated, without any adverse event. CONCLUSION: Tumescence anesthesia and echo-guided compression technique (TACT) is an effective and safe treatment for PA. Compared to other therapies, TACT is minimally invasive and widely available for minimal costs, even for large PA and in unstable patients. CLINICAL IMPACT: Tumescence anesthesia and echo-guided compression technique seems to be an efficient, safe, and a fair economical choice in comparison with alternative techniques. The implementation of this procedure is simple with low risk of complications. Based on the results of this study, we believe that TACT should be considered as the first-line treatment of most iatrogenic PA.

[Chronic headaches due to idiopathic cerebrospinal fluid hypotension treated with sphenopalatine ganglion block]. / Céphalées chroniques sur hypotension de liquide céphalorachidien idiopathique traitées par bloc sphénopalatin.

Sphenopalatine ganglion block (SPGB) is a well-known technique of anesthesia used for the treatment of many types of facial pain syndromes. Its utility in the treatment of headaches due to cerebrospinal fluid hypotension, caused by dural breach or not, seems established but the lack of strong studies proving its efficacy or its superiority compared to epidural blood patch doesn't allow it, for now, to be a part of the official treatment algorithm. We report the case of a patient presenting idiopathic cerebrospinal hypotension (Schaltenbrand syndrome) treated effectively with a sphenopalatine ganglion block using the intranasal approach.

Le bloc du ganglion sphénopalatin (BGSP) est une technique d'anesthésie connue de longue date et utilisée comme proposition de traitement dans de nombreux types de syndromes d'algie de la face. Son utilité dans le traitement des céphalées sur hypotension de liquide céphalorachidien, causées ou non par une brèche durale, semble établie. Cependant, l'absence d'études solides démontrant son efficacité ou sa supériorité par rapport au «blood patch¼ épidural ne permet pas, à l'heure actuelle, de lui donner une place précise dans l'algorithme de prise en charge. Nous rapportons le cas d'un patient présentant un syndrome d'hypotension intracrânienne idiopathique ou spontanée (syndrome de Schaltenbrand) ayant bénéficié d'un traitement efficace par bloc du ganglion sphénopalatin par voie intra-nasale.

Optimization of analgesia for piglet castration under isoflurane anaesthesia with parenteral butorphanol, meloxicam or intratesticular lidocaine.

INTRODUCTION: This blinded prospective study investigated analgesic effects of intramuscular (IM) butorphanol, meloxicam or intratesticular (IT) lidocaine for castration of 7-14 days old piglets under isoflurane anaesthesia. 66 piglets were randomly injected with: meloxicam IM (0.4 mg/kg; group M), butorphanol IM (0.2 mg/kg; group B), or both (group BM) 20 minutes prior to castration, or lidocaine IT (4 mg/kg (group ML4) or 8 mg/kg (group ML8)) together with meloxicam IM (0.4 mg/kg) under anaesthesia with 1.8% end-tidal isoflurane. Heart rate, respiratory rate, mean arterial blood pressure and end-tidal carbon dioxide were recorded. Anaesthesia quality was scored and postoperative behaviour assessed. As butorphanol caused unacceptable side effects, its use was stopped. Group M showed worse anaesthesia quality than ML4 and ML8 (higher incidence of movements: 11/17, 3/18 and 4/17, respectively). There were no significant differences between groups regarding parameters measured during castration. Postoperative behaviour did not differ between groups. For castration of 7-14 days old piglets under isoflurane anaesthesia, IT lidocaine provides an additional side effect free analgesia.

INTRODUCTION: Cette étude prospective en aveugle étudie l'effet analgésique de l'injection intramusculaire (IM) de butorphanol et de méloxicam ou de l'injection intra-testiculaire (IT) de lidocaïne pour la castration, sous anesthésie à l'isoflurane, de porcelets âgés de 7 à 14 jours. Soixante-six porcelets ont reçu de manière aléatoire soit du méloxicam IM (0.4 mg/kg; groupe M), soit du butorphanol IM (0.2 mg/kg; groupe B), soit les deux substances (groupe MB) 20 minutes avant la castration, soit de la lidocaïne IT (4 mg/kg (groupe ML4) ou 8 mg/kg (groupe ML8)) ainsi que du méloxicam IM (0.4 mg/kg), avec une anesthésie à l'isoflurane à 1.8% en fin d'expiration. Les fréquences cardiaques et respiratoires, la pression artérielle moyenne et le CO2 en fin d'expiration ont été documentés. La qualité de l'anesthésie a été estimée et le comportement post-opératoire observé. Le butorphanol a causé des effets secondaires inacceptables et son usage a été stoppé. Le groupe M montrait une plus mauvaise qualité d'anesthésie que les groupes ML4 et ML8 (plus grande incidence de mouvements : 11/17, 3/18 et 4/17). Les autres paramètres intra opératoires ne présentaient pas de différences significatives et on a pas constaté de différences entre les groupes dans la phase postopératoire. Pour la castrations de porcelets âgés de 7 à 14 jours sous anesthésie à l'isoflurane, l'utilisation intra testiculaire de lidocaïne représente une analgésie supplémentaire dépourvue d'effets secondaires.

Sucralfate and Lidocain: Antacid 50:50 solution in Post Esophageal Variceal Band Ligation Pain.

OBJECTIVE: To compare the effectiveness of pain relief of Sucralfate and lidocain antacid 50:50 solution in post esophageal variceal band ligation pain. METHODS: All patients who had under gone Esophageal Variceal Band Ligation (EVBL) were included in the study. Patients un-willing to be included in the study or those who didn't have post EVBL pain were excluded. Patients with post EVBL pains were divided into two groups: one group was given sucralfate and other was given lidocaine: antacid 50:50 solution. Both were inquired about the duration of the pain relief after the medication. The results were analyzed on SPSS 23. Independent samples T-test was performed to find out whether the difference in duration of pain relief was significantly different in the two groups. RESULTS: Out of 110 patients who have EVBL, 66(60.00%) had pain and 44(40.00%) were pain free. In the pain group 46 (69.7%) were given sucralfate and 20 (30.3%) were given lidocain: antacid 50:50 solution. Mean duration of pain relief in two groups was 2.78 (SD ± 2.096) and 2.5 days (SD ±. 0.76) respectively. Independent samples T-test results revealed that there was no statistically significant difference in the duration of pain relief between these two groups with p value 0.426. CONCLUSION: Both Sucralfate and Lidocain: antacid 50:50 solutions are effective in relieving the post EVBL pain. However, no statistically significant difference in duration of pain relief was detected in separate groups of patients treated with either treatment.

Steroids, lidocain and ioxaglic acid modify the viscosity of hyaluronic acid: in vitro study and clinical implications.

BACKGROUND: Viscosupplementaion by intra-articular injection of hyaluronic acid (HA) is a therapeutic modality for treating osteoarthritis of the knee, of the hip and less frequently of other joints. During viscosupplementation, it is usual to inject other drugs, without knowing whether this association may have a deleterious effect thereon. The rheological properties of a viscosupplement are highly dependent on the product [molecular weight × concentration] of HA. Therefore, any reduction of its viscoelastic properties is related either to a decrease of its concentration or/and of its molecular weight. The presence of other molecules can create favorable or unfavorable molecular interactions with HA. The objective of the study was to investigate the effect of products, that are commonly associated with HA (corticosteroids, lidocain, iodinated contrast media), on the rheological behavior of HA, then to try drawing practical conclusions. METHODS: The rheological behavior of both a linear and a cross-linked HA, was studied before and after mixing with different volumes (ratio 1:0.5-1:4) of the following compounds: phosphate buffered saline (PBS, as a control), cortivazol, triamcinolone hexacetonide, lidocain chlorhydrate and meglumine ioxaglate. The flow curve of the different samples was obtained using a measuring method based on a constant shear rate. RESULTS: Whatever the dilution and the added molecule were, viscosity of the cross-linked viscosupplement remained much higher than that of the linear one. Addition of PBS at a ratio 1:1 caused a dramatic decrease (up to 97.5 %) of HA viscosity. Cortivazol and lidocain had a similar effect than PBS on linear HA. Both were much deleterious on cross-linked HA viscosity. Among corticosteroids, triamcinolone decreased much less HA viscosity than cortivazol. The effect of meglumine ioxaglate was dose-dependent. Up to a ratio 1:1 viscosity of the linear HA remained above the dilution effect. On the cross-linked HA, the deleterious effect of the contrast agent was evident as soon as a ratio 1:1 and became very marked at 1:2. CONCLUSION: HA viscosity varies widely in presence of other molecules. These changes are due to both dilution and molecular interactions. This study suggests that addition of other molecules with HA can lead to a major decrease of its viscosity. However, provided to respect a maximum ratio of 1:1, the contrast medium and triamcinolone seem to have no major deleterious effect on the viscosity level, especially on crosslinked HA. The study also suggests a deleterious effect of lidocain on the cross-linked HA. These in vitro data suggest that drugs associations must be avoided when they are not essential. However, clinical trials are needed to determine whether these rheological changes may have a significant impact on the clinical outcome.

Avaliação da pressão intraocular e exoftalmometria pré e pós-bloqueio peribulbar em pacientes submetidos à facectomia / Intraocular pressure and exotalmometer evaluation before and after peribulbar anaesthesia in cataract surgery

OBJETIVOS:Comparar os efeitos sobre a PIO após o bloqueio peribulbar com lidocaína e bupivacaína em pacientessubmetidos à cirurgia de facectomia com implante de lente intraocular (LIO), bem como avaliar indiretamente e comparar a distribuição dos anestésicos na órbita com a medida da exoftalmometria antes e após a anestesia peribulbar. A bupivacaína e a lidocaína são anestésicos locais que rotineiramente têm sido utilizados para realização de bloqueio peribulbar. Sabe-se que a pressão intraocular (PIO) é um fator importante no pré-operatório imediato da cirurgia de catarata para evitar possíveis complicações como perda vítrea e hérnia de íris. MÉTODOS: Cinquenta pacientes de ambos os sexos, com idade entre 48 e 93 anos, com avaliação pré-anestésica ASA I e II, foram randomizados após a conclusão da pesquisa em 2 grupos: Grupo 1: os que receberam lidocaína e Grupo 2: os que receberam bupivacaína. A medida da PIO foi realizada e analisada em 4 momentos: Antes da anestesia; 1 minuto após o bloqueio; 5 minutos após o bloqueio; 7 minutos após o bloqueio. Também foi avaliado a exoftalmometria antes e imediatamente após o bloqueio com exoftalmômetro de Luedde. RESULTADOS: Houve um aumento na medida da PIO com o bloqueio anestésico nos dois grupos comparados, porém não houve diferença estatisticamente significante no aumento da PIO quando comparada as duas drogas analisadas. Quando comparamos a exoftalmometria, identificamos que não houve diferença estatisticamente significante no aumento da proptose em relação aos dois grupos, isto é, os dois anestésicos quando comparados distribuem-se da mesma forma na cavidade orbitária. CONCLUSÃO: Não houve diferença na variação do aumento da PIO e da na variação da exoftalmometria entre os dois anestésicos comparados.

PURPOSE: To compare the effects of IOP after peribulbar anaesthesia with lidocain and bupivacain for cataract surgerywith intraocular lens implantation and evaluate exoftalmometer results after the same procedure. Bupivacain and lidocain are local drugs used for peribulbar anaesthesia. It is known that intraocular pressure (IOP) is an important factor for cataract surgery to avoid complications like vitreous loss and iris hernia. METHODS: Fifty male and female patients, between 48 and 93 years old, with ASA I and II evaluation before anaesthesia were recruted to participate for this study. We had 2 groups for the study. Group 1: lidocain patients and group 2: bupivacain patients. Intraocular pressure was measured in 4 different periods: before peribulbar anaesthesia, 1 minute, 5 minutes and 7 minutes after. We also performed exoftalmometer evaluation before and right after peribulbar anaesthesia with Luedde exoftalmometer. RESULTS: There was higher IOP after peribulbar anaesthesia, but not significant when compared between both drugs. The exoftalmometer evaluation showed that both drugs are equal distributed in orbit and they both cause proptosis of the ocular globe. CONCLUSION: There was no difference comparing higher intraocular pressure or exoftalmometer evaluation between both drugs.

Evaluación de la tensión arterial de pacientes preeclámpticas, que reciben anestesia epidural: Lidocaína mas Epinefrina / Evaluation of the arterial tension of preeclamptic patients that receive epidural anesthesia: Lidocain-Epinephrin

Tipo de estudio: retrospectivo, longitudinal y analítico.Objetivos:•Evaluar el comportamiento de la tensión arterial materna, durante la operación cesárea de pacientes preeclámpticas que reciben anestesia epidural con lidocaína al 2% con epinefrina al 1:200,000.•Evaluar si la utilización de lidocaína con epinefrina afecta la hemodinamia materna, hasta contraindicarla en la anestesia epidural de la paciente preeclámptica. Hipótesis: La epinefrina en la anestesia epidural, produce crisis hipertensiva en las pacientes preeclámpticas.Resultados: Una vez instalada la anestesia epidural, las tensiones arteriales mostraron un descenso gradual, más acentuado al minuto 35 posterior a la administración de la dosis total de lidocaína con epinefrina, que corresponden a la máxima extensión metamérica y a la mayor profundidad obtenida con el bloqueo epidural, así como a la descompresión abdominal y a la hemorragia quirúrgica tras la extracción del producto; conforme aumentó la cantidad perfundida de soluciones intravenosas, la tensión arterial inició un ascenso paulatino sin haber requerido soporte vasopresor. Ninguna paciente respondió con crisis hipertensiva a la administración de lidocaína con epinefrina. Conclusiones: Se concluye que en cesárea de preeclampticas previamente tratadas, la anestesia epidural fraccionando lidocaína con epinefrina no produce hipertensión arterial ni colapso vascular materno, se pueden predecir y por lo tanto evitar los descensos tensionales

Type of study: retrospective, longitudinal and analytic studyObjectives: •To evaluate the behavior of the maternal arterial tension, during the Caesarean operation of preeclamptic patients that received epidural anesthesia with lidocain 2% with epinephrin 1:200,000.•To evaluate if the lidocain used with epinephrin affects the maternal hemodynamic, that it would lead to contraindicate it in the epidural anesthesia of the preeclamptic patient. Hypothesis: The enunciated hypothesis was: The epinephrin in the epidural anesthesia, produces hipertensive crisis in the preeclamptic patients.Results: Once the epidural anesthesia is administered , the arterial tensions showed a gradual decrease, accentuated 35 minute later to the administration of the total dose of lidocain with epinephrin that corresponds to the maximum metametric extension and the biggest depth obtained with the epidural block. Also to abdominal decompression and the surgical hemorrhage after the extraction of the product. As the quantity of intravenous solutions are prefused increases, the arterial tension increases it began a gradual increase without having required vasopressor support. No patient responded with hipertensive crisis to the lidocain administration with epinephrin. Conclusions: We conclude that in Caesarean operation of previously treated preeclamptic patients, the epidural anesthesia fractioning lidocain with epinephrin doesn't produce hypertension nor maternal vascular collapse, they can be predicted and therefore be able to avoid a decrease in arterial tension.