Sufentanil, dexmedetomidine combined with surface anesthesia for awake fiberoptic nasotracheal intubation in the patient with severe mouth opening difficulty undergoing wedge resection of the right upper lung: A case report and literature review.

BACKGROUND: Severe mouth opening difficulty may increase the risk of airway management during anesthesia induction, and awake fiberoptic nasotracheal intubation (AFNI) is the first option for patients with orofacial anatomical changes. CASE SUMMARY: A 54-year-old man was scheduled to undergo wedge resection of the right upper lung in August 2021. The patient had a history of enlarged right maxillary lesion resection and partial right maxillary resection surgery in April 2020, which led to orofacial anatomical changes and severe mouth opening difficulty. To avoid difficult airway-related emergency scenarios, the AFNI was successfully performed through intravenous injection of sufentanil and dexmedetomidine combined with lidocaine topical anesthesia under a conscious state without any uncomfortable feeling or complications. CONCLUSIONS: Intravenous injection of sufentanil and dexmedetomidine combined with lidocaine topical anesthesia can be used as an alternative medication scheme to relieve uncomfortable suffering for AFNI in patients with severe mouth opening difficulty.

Bufotenines-loaded liposome exerts anti-inflammatory, analgesic effects and reduce gastrointestinal toxicity through altering lipid and bufotenines metabolism.

Bufotenines, a natural component from toad venom, showed great potential for development as a novel anti-inflammation and analgesia agent, but the potential toxicity limited its clinic use. In this paper, bufotenines-loaded liposome was prepared and optimized. Then, the therapeutic effects and drug safety of bufotenines-liposome were investigated against inflammation and pain on animal models, with a focus on gastrointestinal toxicity. Bufotenines and its liposome significantly increased paw withdrawal mechanical threshold (PWMT) in Von Frey test and hot paw withdrawal latency (HPWL) in hot-plate test. Moreover, intestinal absorption in vitro and pathological analysis in vivo showed that total bufotenines-loaded liposome significantly reduced the gastrointestinal irritation through reducing exposure of total bufotenines on intestinal tissue. High-sensitivity lipidomics analysis revealed the effect of total bufotenines-loaded liposome were be related to the down-regulation of inflammatory mediators from cyclooxygenase (COX) and lipoxygenase (LOX), the up-regulation of cytochrome P450 (CYP450), and other pathways, thus regulating lipid metabolism pathway and ultimately reducing gastrointestinal irritation. This study shows that liposome-loaded bufotenines has anti-inflammatory, analgesic effects and achieves toxicity reduction. These results provide systematic evidences for efficacy and safety of toad venom active ingredients.

Effect of continuous infusion of dexmedetomidine on blood loss in orthognathic surgery: a retrospective study.

BACKGROUND: Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with haematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension and may reduce blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries. METHODS: The primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level; intraoperative heart rate and blood pressure (T1: at incision; T2: 30 min after incision; T3: 60 min after incision; T4: 120 min after incision); dosage of fentanyl, remifentanil, urapidil, and esmolol; operation time; and incidence of allogeneic blood transfusion. RESULTS: A total of 1247 patients were included in this study, and 540 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1-T4, blood pressure at T1, and remifentanil and esmolol dosage in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group. CONCLUSIONS: Continuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery. TRIAL REGISTRATION: ChiCTR1800018794 (retrospectively registered) Name of registry: Chinese Clinical Trial Registry Date of registration: 2018/10/09 URL: www.chictr.org.cn/showproj.aspx?proj=30612.

[Effects of remifentanil and dexmedetomidine on recovery profiles after oral and maxillofacial surgery].

PURPOSE: To investigate the effects of remifentanil and dexmedetomidine on recovery period after oral and maxillofacial surgery. METHODS: Sixty cases undergoing oral and maxillofacial surgery were randomly divided into 3 groups, including remifentanil group (group R), dexmedetomidine group (group D) and normal saline group (group C). Ten minutes before the end of surgery, the patients were given target control infusion of remifentanil at effect-site concentration of 1.5 ng/mL in group R or dexmedetomidine 0.5 µg/kg in group D or normal saline in group C, respectively. The haemodynamic parameters, Ramsay scales, coughing, agitation were recorded. Extubation time and incidence of adverse events were observed as well. Statistical analysis was performed using SPSS20.0 software package. RESULTS: The mean arterial pressure and heart rate at the time of extubation were significantly lower in group D and group R than those in group C (P<0.05). The Ramsay scores were significantly better in group D and group R than in group C at the time point of 5 minutes and 10 minutes after extubation , and the score in group D was better than in group R at the same time (P<0.05). The incidences of coughing and agitation were significantly lower in group D and group R than in group C (P<0.05). There was no significant difference in extubation time. CONCLUSIONS: Dexmedetomidine and remifentanil can reduce the haemodynamic responsiveness, coughing and agitation during the recovery period of oral and maxillofacial surgery without extending the extubation time. Dexmedetomidine can provide longer sedation time than TCI of remifentanil.

Urethral reconstruction with a 3D porous bacterial cellulose scaffold seeded with lingual keratinocytes in a rabbit model.

The goal of this study was to evaluate the effects of urethral reconstruction with a three-dimensional (3D) porous bacterial cellulose (BC) scaffold seeded with lingual keratinocytes in a rabbit model. A novel 3D porous BC scaffold was prepared by gelatin sponge interfering in the BC fermentation process. Rabbit lingual keratinocytes were isolated, expanded, and seeded onto 3D porous BC. BC alone (group 1, N = 10), 3D porous BC alone (group 2, N = 10), and 3D porous BC seeded with lingual keratinocytes (group 3, N = 10) were used to repair rabbit ventral urethral defects (2.0 × 0.8 cm). Scanning electron microscopy revealed that BC consisted of a compact laminate while 3D porous BC was composed of a porous sheet buttressed by a dense outer layer. The average pore diameter and porosity of the 3D porous BC were 4.23 ± 1.14 µm and 67.00 ± 6.80%, respectively. At 3 months postoperatively, macroscopic examinations and retrograde urethrograms of urethras revealed that all urethras maintained wide calibers in group 3. Strictures were found in all rabbits in groups 1 and 2. Histologically, at 1 month postoperatively, intact epithelium occurred in group 3, and discontinued epithelium was found in groups 1 and 2. However, groups 2 and 3 exhibited similar epithelial regeneration, which was superior to that of group 1 at 3 months (p < 0.05). Comparisons of smooth muscle content and endothelia density among the three groups revealed a significant increase at each time point (p < 0.05). Our results demonstrated that 3D porous BC seeded with lingual keratinocytes enhanced urethral tissue regeneration. 3D porous BC could potentially be used as an optimized scaffold for urethral reconstruction.