Aaron J. Kaye

The Effect of Deep-Tissue Massage Therapy on Blood Pressure and Heart Rate

AIM In the present study, we describe the effects of deep tissue massage on systolic, diastolic, and mean arterial blood pressure. MATERIALS AND METHODS The study involved 263 volunteers (12% males and 88% females), with an average age of 48.5. Overall muscle spasm/muscle strain was described as either moderate or severe for each patient. Baseline blood pressure and heart rate were measured via an automatic blood pressure cuff. Twenty-one (21) different soothing CDs played in the background as the deep tissue massage was performed over the course of the study. The massages were between 45 and 60 minutes in duration. The data were analyzed using analysis of variance with post-hoc Scheffes F-test. RESULTS Results of the present study demonstrated an average systolic pressure reduction of 10.4 mm Hg (p<0.06), a diastolic pressure reduction of 5.3 mm Hg (p<0.04), a mean arterial pressure reduction of 7.0 mm Hg (p<0.47), and an average heart rate reduction of 10.8 beats per minute (p<0.0003), respectively. CONCLUSIONS Additional scientific research in this area is warranted.

Pharmacology of herbals and their impact in anesthesia.

Introduction Over one half of Americans currently take dietary supplements, and up to 33% may be using herbals in place of prescription medications [1–3]. Anecdotal reports on efficacy, heavy marketing, lower costs compared with prescription medications, and accessibility are a few of the reasons for this increase in prevalence. Furthermore, many patients will not disclose their consumption of these products to their physicians. Such products do not require approval from the US Food and Drug Administration, and consequently herb–drug interactions may occur. Herbals are actually considered foods by the Food and Drug Administration, and they do not undergo any of the vigorous tests required to achieve drug status, including ensuring specific bioavailability, standardization, limitation of adulterants, and therapeutic efficacy. It is imperative that physicians, particularly the anesthesiologist, be cognizant of the potential pharmacologic effects of these herbals. In this review we discuss some of the most commonly used herbal supplements and their pharmacology.

Vasculoprotective effect of U50,488H in rats exposed to chronic hypoxia: role of Akt-stimulated NO production

Impairment of pulmonary endothelium function in the pulmonary artery is a direct result of chronic hypoxia. This study is to investigate the vasculoprotective effects of U50,488H (a selective κ-opioid receptor agonist) and its underlying mechanism in hypoxia-induced pulmonary artery endothelial functional injury. Chronic hypoxia was simulated by exposing the rats to 10% oxygen for 2 wk. After hypoxia, right ventricular pressure (RVP) and right ventricular hypertrophy index (RVHI) were measured. The pulmonary vascular dysfunction, effect of nitric oxide synthase inhibitor (l-NAME) on the relaxation of U50,488H, and level of nitric oxide (NO) were determined. In vitro, the signaling pathway involved in the anti-apoptotic effect of U50,488H was investigated. Cultured endothelial cells were subjected to simulated hypoxia, and cell apoptosis was determined by TUNEL staining. U50,488H (1.25 mg/kg) significantly reduced RVP and RVHI in hypoxia. U50,488H markedly improved both pulmonary endothelial function (maximal vasorelaxation in response to ACh: 74.9 ± 1.8%, n = 6, P <0.01 vs. hypoxia for 2 wk group) and increased total NO production (1.65 fold). U50,488H relaxed the pulmonary artery rings of the hypoxic rats. This effect was partly abolished by l-NAME. In cells, U50,488H both increased NO production and reduced hypoxia-induced apoptosis. Moreover, pretreatment with nor-binaltorphimine (nor-BNI, a selective κ-opioid receptor antagonist), PI3K inhibitor, Akt inhibitor or l-NAME almost abolished anti-apoptotic effect exerted by U50,488H. U50,488H resulted in increases in Akt and eNOS phosphorylation. These results demonstrate that pretreatment with U50,488H attenuates hypoxia-induced pulmonary vascular endothelial dysfunction in an Akt-dependent and NO-mediated fashion.

Role of κ-opioid receptor in hypoxic pulmonary artery hypertension and its underlying mechanism.

The objective of this study were to determine the mechanism of action and role of the &kgr;—opioid receptor (&kgr;-OR) on hypoxic pulmonary artery hypertension (HPH) in the rat and its underlying mechanisms. The effect of U50,488H, a selective &kgr;-OR agonist, on the proliferation of pulmonary arterial smooth muscle cells (PASMCs) under hypoxic conditions were measured by monotetrazolium assay and [3H]-thymidine incorporation. Effects of U50,488H and nor-BNI, a highly selective &kgr;-OR antagonist, on expression of &kgr;-ORs were determined by Western blot technique. The results of our study demonstrated that U50,488H significantly lowered both mean pulmonary artery pressure and right ventricular pressure in HPH rats (P < 0.01). Further, this effect was abolished by nor-BNI (P < 0.01). Further, the effect of the agonist U50,488H was abolished by the antagonist nor-BNI (P < 0.01). mean pulmonary artery pressure and right ventricular pressure were both significantly upregulated in HPH rats treated with nor-BNI versus HPH control group rats (P < 0.01). Moreover, U50,488H inhibited proliferation of the PASMCs that were induced by hypoxia, and this inhibition lasted for 48 hours in a dose-dependent manner (P < 0.01). The inhibitory effect that U50,488H exerted on PASMC proliferation was also abolished by nor-BNI. During hypoxia, the expression of &kgr;-ORs increased in the pulmonary artery. This increase of &kgr;-OR expression was both enhanced by U50,488H and abolished by nor-BNI. The results demonstrate that U50,488H attenuates HPH through both the stimulation and upregulation of &kgr;-ORs.

Emerging roles of liposomal bupivacaine in anesthesia practice

Despite advances in drug technology and improvements in technology, including peripheral nerve catheters and ultrasound, postoperative pain is still a significant problem in the clinical setting worldwide. Postoperative pain can have a critical negative impact with regard to physiological consequences to the body and therefore, the role of liposomal bupivacaine as an extended release bupivacaine with approximately 72 h of duration may have far-reaching and significant impact in clinical practice. Liposomal bupivacaine has a DepoFoam multivesicular liposome technology with particle suspension in an isotonic aqueous solution and consists of tiny lipid-based particles, which contain discrete water-filled chambers dispersed through a lipid matrix. Other advantages include a reduction in opioid consumption, while not requiring a catheter or any other device, as well as easy dilution with saline. This review summarizes current research with this novel agent in postsurgical pain, and discusses potential roles in chronic pain states. Further studies are warranted for its use in epidural and intrathecal administration. Moreover, this review will explore the expansion of liposomal bupivacaines current clinical role.

Preoperative Assessment for Ambulatory Surgery

Purpose of ReviewAmbulatory surgery has grown in recent decades in volume and represents a significant number of anesthetics delivered throughout the USA. Preoperative anesthetic assessment in the ambulatory setting has become important because patients with numerous complex comorbidities are now commonplace in this arena. Disease states involving the lungs, the heart, the kidneys, and subpopulations including those who are obese and the elderly commonly receive anesthetics in an ambulatory setting.Recent FindingsThis review presents key aspects of current thinking with regard to preoperative assessment and considerations for different critical disease states and subpopulations that are now being managed under ambulatory surgery. Same day surgery centers require patient safety, and expectations are high for patient satisfaction. Advancements in surgical and anesthetic technique have allowed for more complex patients to partake in ambulatory surgery.SummaryAnesthesiologists must be familiar with guidelines, state-of-the-art pain management, and standards of preoperative patient evaluation to accurately stratify patient risk and to advocate for patient safety.

Development of a rat respiratory mask and its application in experimental chronic myocardial ischaemia

In addressing the challenge of the low survival rates of rats with myocardial ischaemia, we developed a novel respiratory mask. We tested this mask on the rat model. We gave attention to several features of the mask: (1) shape, (2) size, (3) inlet, (4) outlet, (5) compatibility between rat head and the mask, (6) connection between mask and ventilator. We found certain features, especially to influence mask efficacy. These features include: mask shape, mask inlet and outlet, mask connection to the respiratory machine, mask mount on the rat head. We examined the rat mask in a model of chronic myocardial ischaemia; our model was the ligation of the coronary artery. The rats with the masks experienced an increase in survival by a factor of 50–90% compared with rats deprived of the masks. Towards the examination of myocardial ischaemia, our new mask may offer a platform replete with both efficiency and stability.

The role of cyclooxygenase in the feline pulmonary vascular bed.

Objective:There are extensive data on roles of cyclooxygenase 1 (COX 1) and cyclooxygenase 2 (COX 2) enzymes in temperature, coagulation, and inflammatory modulation. There is little known of the function of these enzymes in regulating tone in pulmonary vasculature. The purpose of this investigation was to elucidate the roles of COX 1 and 2 enzymes in the feline pulmonary vascular bed. Design:Prospective vehicle controlled study. Setting:University research laboratory. Subjects:Intact chest preparation; adult mongrel cats. Interventions:The effects of intravascular administration of U46619, angiotensin II, prostaglandin E1 (PGE1), arachidonic acid, and norepinephrine, were analyzed before and after intravascular administration of selective COX enzyme inhibitors. Measurements and Main Results:Because lobar arterial flow is constant in these experiments, changes in lobar pressure represent changes in pulmonary arterial resistance. Under constant flow conditions, lobar arterial and systemic pressures were continuously monitored, electronically averaged, and recorded. In the isolated left lower lobe of the feline lung bed, U46619, angiotensin II, arachidonic acid, and norepinephrine induced a dose-dependent vasoconstrictor response. PGE1 induced a dose-dependent vasodepressor response. After administration of the COX 1 inhibitor SC 560, the arachidonic acid-induced vasopressor responses were significantly attenuated while U46619, angiotensin II, and norepinephrine-induced vasopressor, and PGE1-induced vasodepressor responses were not significantly altered. After administration of the COX 2 inhibitor nimesulide, both the PGE 1 vasodepressor responses and arachidonic acid-induced vasopressor responses were significantly decreased while the U46619, angiotensin II, and norepinephrine-induced vasopressor responses were not significantly attenuated. Conclusions:The results of the study indicate that PGE1 has potent vasodepressor effects in the feline lung bed and this response is mediated by COX 2 pathways. The data also suggest that arachidonic acid has potent vasopressor activity in the feline pulmonary vascular bed and this response is mediated by both COX 1 and COX 2 sensitive pathways.

Stem Cell Therapy for Osteonecrosis of the Femoral Head: Current Trends and Comprehensive Review

Purpose of ReviewOsteonecrosis of the femoral head (ONFH) is a common and frequently occurring disease. It is caused by interruption of blood supply with different etiologies. ONFH leads to degeneration and necrosis of the subchondral bone of the femoral head and eventually collapse of the femoral head. ONFH has a high disability rate, seriously affecting the quality of living of patients, and often involves middle-aged and younger people.Recent FindingsIn recent years, the technology and understanding of stem cells and regenerative medicine have been developing rapidly. Numerous studies have reported successful results in the treatment of ONFH by stem cell transplantation. Thus, stem cell transplantation is expected to serve as a new method in the treatment of ONFH. In the present report, therefore, we evaluated current techniques and outcomes utilizing stem cells in the treatment of ONFH. A computer-based online search of PubMed and Cochrane Library databases between January 2006 and June 2017 was performed to search related articles using the keywords of “treatment, stem cell, osteonecrosis of the femoral head” in English language. Literature related to the treatment of ONFH was selected.SummaryOur search obtained a total of 161 articles, but only 9 articles met our inclusion criteria and were included in our report. The present review reveals that cell technology has demonstrated good evidence in the treatment of ONFH. However, this technology needs additional in-depth study to better explore and appreciate more ideal ways to overcome difficulties associated with source of cells.

Pharmacogenomics, precision medicine, and implications for anesthesia care

The study of how individual genetic differences, known as polymorphisms, change the pharmacokinetics and pharmacodynamics of drugs is called pharmacogenomics. As the field of pharmacogenetics grows and continues to identify genetic polymorphisms, it is promising that the unmet need in this patient population may soon be addressed with personalized drug therapy based on the patients genetic composition. Although encouraging, pharmacogenomic testing is underutilized in the United States and is often not covered by insurance companies. This manuscript describes the current state of precision medicine as it relates to perioperative care and how preoperative genomic analysis can help improve patient outcomes. This investigation also outlines future directions in this important and evolving field.