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Ketamine is a racemic mixture of equal amounts of R-ketamine and S-ketamine and is well known to anesthesiologists for its unique dissociative anesthetic properties. The pharmacological properties of ketamine, namely, its sympathetic excitation, mild respiratory depression, and potent analgesia, are still highly valued in its use as an anesthetic for some patients. In particular, since its advent, S-ketamine has been widely used as an anesthetic in many countries due to its increased affinity for NMDA receptors and its enhanced anesthetic and analgesic effects. However, the anesthetic and analgesic mechanisms of S-ketamine are not fully understood. In addition to antagonizing NMDA receptors, a variety of other receptors or channels may be involved, but there are no relevant mechanistic summaries in the literature. Therefore, the purpose of this paper is to review the mechanisms of action of S-ketamine on relevant receptors and systems in the body that result in its pharmacological properties, such as anesthesia and analgesia, with the aim of providing a reference for its clinical applications and research.
RESUMO
Objective: This study aimed to evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cognitive dysfunction (POCD) in older patients with lumbar spine surgery. Methods: Older patients (aged 60-80 years old) receiving lumbar spine surgery under general anesthesia were randomly divided into group A, 3-day intervention group; group B, 7-day intervention group; control group C, sham TEAS group, selected "Baihui" (GV 20) and "Dazhui" (GV 14) point was intervened once 30 min before operation with "HANS" transcutaneous electrical stimulation device, and then once a day after operation for 30 min each time. The primary outcome was the incidence of postoperative cognitive impairment assessed by the use of the Mini Mental Rating Scale (MMSE), patients developed POCD according to the Z score method. The secondary outcome was serum interleukin-6 (IL-6), tumor Necrosis factor α (TNF-α), neuron-specific enolase (NSE), and S100ß protein levels. Results: Three days after surgery, the incidence of POCD in groups A((22.4%)) and B ((18.3%)) were lower than those in group C ((42.9%)) (P < 0.05). There was no significant difference between groups A and B (P > 0.05). Seven days after surgery, the incidence of POCD in group B (18.3%) was lower than that in groups A (26.5%) and B (42.9%), and the comparison between groups B and C was statistically significant (P < 0.05). On the 3rd and 7th days after surgery, the levels of IL-6, TNF-α, NSE, and S100ß in the two TEAS groups were lower than those in the sham TEAS group (P < 0.01), but higher than the preoperative levels in the three groups (P < 0.01). Conclusion: It seems that Perioperative TEAS intervention could reduce the level of inflammatory factors IL-6, TNF-α in the blood of older patients with lumbar spine surgery, and reduce the incidence of POCD. Clinical trial registration: www.chictr.org.cn, identifier ChiCTR2200063030.
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BACKGROUND: Kinesio tape (KT) may be useful for the treatment of delayed onset muscle soreness (DOMS), but there has been no systematic review assessing their efficacy. OBJECTIVES: We conducted a systematic review and meta-analysis to evaluate the efficacy of KT on DOMS. METHODS: We searched seven databases for randomized controlled trials (RCTs) and crossover randomized trials of KT in DOMS, from the earliest date available to December 31, 2019. The primary outcome was muscle soreness. The secondary outcome was muscle strength and serum creatine kinase (CK) level. The risk of bias was evaluated based on the Cochrane criteria. Data were analyzed using RevMan version 5.3.0 software. P values < 0.05 were considered statistically significant. Systematic review registration number is CRD42020157052. RESULTS: Eight trials (six RCTs and two crossover randomized trials) with 289 participants were included. KT use significantly reduced muscle soreness at 48 h (mean difference (MD): -0.67, 95% confidence interval (CI): -1.10 to 0.24, P = 0.002) and 72 h postexercise (MD: -0.81, 95% CI: -1.45 to -0.17, P = 0.01) but not at 24 h. KT use improved muscle strength at 72 h postexercise (standardized mean difference: 0.35, 95% CI: 0.02 to 0.69, P = 0.04) but not at 24 or 48 h. However, the serum CK level at 24, 48, and 72 h postexercise was not better in the KT group relative to the control group. CONCLUSIONS: Current evidence suggests that KT might help to alleviate DOMS after strenuous exercise to improve muscle strength. Thus, using KT on the skin for more than 48 hours postexercise, but not for 24 h, appears more effective at relieving pain and improving muscle strength.
