Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil

The potential value of exosomes as adjuvants for novel biologic local anesthetics

The side effects of anesthetic drugs are a key preoperative concern for anesthesiologists. Anesthetic drugs used for general anesthesia and regional blocks are associated with a potential risk of systemic toxicity. This prompted the use of anesthetic adjuvants to ameliorate these side effects and improve clinical outcomes. However, the adverse effects of anesthetic adjuvants, such as neurotoxicity and gastrointestinal reactions, have raised concerns about their clinical use. Therefore, the development of relatively safe anesthetic adjuvants with fewer side effects is an important area for future anesthetic drug research. Exosomes, which contain multiple vesicles with genetic information, can be released by living cells with regenerative and specific effects. Exosomes released by specific cell types have been found to have similar effects as many local anesthetic adjuvants. Due to their biological activity, carrier efficacy, and ability to repair damaged tissues, exosomes may have a better efficacy and safety profile than the currently used anesthetic adjuvants. In this article, we summarize the contemporary literature about local anesthetic adjuvants and highlight their potential side effects, while discussing the potential of exosomes as novel local anesthetic adjuvant drugs.

To Stay Safe Walking, Follow the Rules of the Road: Anesthesia for Cesarean Section in the Setting of Myocardial Infarction, a Case Report

: Meany factors lead to myocardial infarction in a pregnant woman, resulting in the increasing prevalence of women with cardiac diseases during pregnancy. There are special considerations for anesthetic care under this condition. This report presents a 40-year-old woman admitted for emergent cesarean section due to acute myocardial infraction (AMI). Providing safe and balanced anesthesia while managing cardiac events was challenging; however, it was performed in accordance with standard anesthesiologic rules.

A comparison of the effects of ENTONOX inhalation and spinal anesthesia on labor pain reduction and apgar score in vaginal delivery: a clinical trial study

INTRODUCTION

The purpose of the present study was to compare the effect of ENTONOX inhalation and spinal injection on the reduction of labor pain, the Apgar score of the neonates, and their side effects on new-born children and pregnant women.

MATERIAL AND METHODS

The present clinical trial study is conducted among the pregnant women in the maternity ward of a child delivery hospital in Iran. All Participants were divided in two groups ENTONOX Inhalation and Spinal Anesthesia. Visual Analogue Scale (VAS) was implemented to measure the pain level experienced by the participants during the procedure. Moreover, the Apgar scale was used to measure the general physical health of the neonates in both groups. In addition, the participants receiving ENTONOX were asked to report the side effects they underwent during gas inhalation. However, the participants in the spinal anesthesia were checked three times. Statistical analysis was performed using SPSS version 22.

RESULTS

The findings showed that the spinal anesthesia technique was significantly more effective than gas inhalation in that it reduced as much as 3 points more than did the inhalation (P-value: 0.001). Moreover, the comparison of the mean Apgar scores showed that the mean Apgar score of the neonates of spinal anesthesia mothers was 0.36 point lower than that of the neonates in the gas inhalation group. However, this difference was not statistically significant at P- value = 0.06.

CONCLUSIONS

the result of the present study indicated that spinal anesthesia was more effective than ENTONOX inhalation in reducing the labor pain.

B. S, Pandarpurkar S, Jajee P. Intrathecal Midazolam as an Adjuvant in Pregnancy-Induced Hypertensive Patients Undergoing an Elective Caesarean Section: A Clinical Comparative Study

Background

A pain-free postoperative period is essential following a caesarean section so new mothers may care for and bond with their neonates. Intrathecal adjuvants are often administered during this procedure to provide significant analgesia, but they may also have bothersome side effects. Intrathecal midazolam produces effective postoperative analgesia with no significant side effects.

Objectives

This prospective, randomized, double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam vs. plain bupivacaine as an adjunct to bupivacaine in pregnancy-induced hypertension patients scheduled for elective caesarean section.

Methods

Sixty patients diagnosed with pregnancy-induced hypertension on regular treatment who were scheduled for a caesarean section were randomly allocated into two groups: a control group (Group BC, n = 30) and a midazolam group (Group BM, n = 30). Both groups received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine. Group BC received 0.4 mL of distilled water, while group BM received 0.4 mL (2 mg) of midazolam intrathecally. The duration of postoperative analgesia, analgesic requirements during the first 24 hours after surgery, onset times and durations of sensory and motor blocks, incidence of hypotension, vasopressor requirements, and side effects were recorded.

Results

Postoperative analgesia was significantly longer in the midazolam group compared to the control group (201.5 minutes vs. 357.6 minutes). The mean onset times of the sensory and motor blocks were significantly faster (P < 0.01) in the midazolam group compared to the control group. The mean times to attain the maximum sensory level and motor blocks were also significantly faster in the midazolam group compared to the control group (P < 0.05). The incidence of hypotension was 6.6% in the midazolam group and 36.6% in the control group, which was highly significant. In addition, the number of patients with side effects was significantly lower in the midazolam group compared to the control group.

Conclusions

Intrathecal midazolam 2 mg provides significantly longer and effective postoperative analgesia with no side effects.

Efficacy of intrathecal midazolam in potentiating the analgesic effect of intrathecal fentanyl in patients undergoing lower limb surgery

Introduction:

The intrathecal administration of combination of drugs has a synergistic effect on the subarachnoid block characteristics. This study was designed to study the efficacy of intrathecal midazolam in potentiating the analgesic duration of fentanyl along with prolonged sensorimotor blockade.

Materials and Methods:

In a double-blind study design, 75 adult patients were randomly divided into three groups: Group B, 3 ml of 0.5% hyperbaric bupivacaine; Group BF, 3 ml of 0.5% hyperbaric bupivacaine + 25 mcg of fentanyl; and Group BFM, 3 ml of 0.5% hyperbaric bupivacaine + 25 mcg of fentanyl + 1 mg of midazolam. Postoperative analgesia was assessed using visual analog scale scores and onset and duration of sensory and the motor blockade was recorded.

Results:

Mean duration of analgesia in Group B was 211.60 ± 16.12 min, in Group BF 420.80 ± 32.39 min and in Group BFM, it was 470.68 ± 37.51 min. There was statistically significant difference in duration of analgesia between Group B and BF (P = 0.000), between Group B and BFM (P = 0.000), and between Group BF and BFM (P = 0.000). Both the onset and duration of sensory and motor blockade was significantly prolonged in BFM group.

Conclusion:

Intrathecal midazolam potentiates the effect of intrathecal fentanyl in terms of prolonged duration of analgesia and prolonged motor and sensory block without any significant hemodynamic compromise.