Bilateral sphenopalatine ganglion block versus intravenous clonidine premedication for surgical field improvement and postoperative pain relief in endoscopic sino-nasal surgery

ackground: Bilateral sphenopalatine ganglion block (SPGB) and IV clonidine premedication could provide better hemodynamic parameters, surgical field, postoperative pain control during endoscopic sino-nasal surgery. Design: prospectiverandomized controlled comparative study. Methods: A total of 69 patients of ASA grade I or II scheduled for endoscopic sino-nasal surgery were equally divided into three groups (23 patients each): control group; block group; and clonidine group. The sphenopalatine ganglion block technique done by lateral infra-zygomatic approach guided by x-ray fluoroscopy. Iv clonidine premedication was given 15 min before general anesthesia induction with dose 2 µg/kg as singe bolus. Surgical field quality assessment done by average category scale (ACS), hemodynamic profile and consumption of anesthetics were recorded. Postoperative pain evaluated by VAS. The time to first request for analgesia, analgesic requirement for 24 h postoperatively and any complications were recorded. Results: MAP and HR readings at most of intra and postoperative times, Average category scale score, intraoperative blood loss, average consumption of fentanyl and propofol and hypotensive agent (labetalol) were significantly high in control group when compared with block and clonidine groups and were significantly low in block group when compared with clonidine group except for postoperative HR.VASscore postoperatively, Time of first request of analgesia, Total pethidine consumption was significantly high in control group C when compared with block and clonidine groups. Conclusion: SPGB is effective for better hemodynamic control, surgical field and postoperative analgesia in endoscopic sino-nasal surgery when compared with IV clonidine premedication

Mesenchymal stromal cell injection protects against oxidative stress in Escherichia coli-induced acute lung injury in mice.

BACKGROUND AIMS: Stem cells may be a promising therapy for acute respiratory distress syndrome. Recent in vivo and in vitro studies suggested that the mesenchymal stromal cells (MSCs) have anti-oxidative stress properties. We hypothesized that intravenous injection of bone marrow-derived mesenchymal stem cells (MSCs) could attenuate Escherichia coli-induced acute lung injury (ALI) in mice by controlling the oxidative stress status. METHODS: Eighty mice were randomly divided into four groups: group 1 (control group) received 25 µL of saline as a vehicle; group 2 contained E coli-induced ALI mice; group 3 included mice that received MSCs before induction of ALI; group 4 included mice that received MSCs after induction of ALI. Lung samples were isolated and assayed for oxidative stress variables and histopathologic analysis. Total anti-oxidant capacity was measured in broncho-alveolar lavage. RESULTS: Pre- and post-injury MSC injection increased survival, reduced pulmonary edema and attenuated lung injuries in ALI mice. Histologically, MSCs exhibited a considerable degree of preservation of the pulmonary alveolar architecture. An increase of anti-oxidant enzyme activities and a decrease of myeloperoxidase activity and malondialdehyde levels in the MSC recipient groups versus the ALI group were found. Furthermore, the total anti-oxidant capacity and reduced glutathione levels were significantly increased in MSCs recipient groups versus the ALI group. Weak +ve inducible nitric oxide synthase immuno-expression in groups that received MSCs was detected. Pre-injury MSC injection showed better effects than did post-injury MSC injection. CONCLUSIONS: Systemic bone marrow-derived MSC injection was effective in modulating the oxidative stress status in E coli-induced acute lung injury in mice.